Axial load-share ratio testing to assess the healing of open tibial fractures treated with the Taylor Spatial Frame

Background:The Taylor Spatial Frame(TSF)has gained popularity among orthopedic surgeons for treating open fractures.However,a key challenge is the timely and safe removal of the frame.This study assessed the efficacy and safety of axial load-share ratio(ALSR)testing to evaluate callus healing strength after TSF treatment of open tibial fractures.Methods:A retrospective case-control study was conducted,analyzing 180 adult patients with open tibial fractures treated at Tianjin Hospital’s Orthopedic Limb Correction Unit between August 2019 and August 2022.All patients underwent TSF external fixation surgery,and were divided into two groups based on ALSR testing.Group I(92 patients)underwent ALSR testing,with frame removal if the test value fell below 5%.Traditional methods were used for fixator removal guidance in Group II(88 patients).Clinical outcomes,including fixation duration,complications after fixator removal,and Johner-Wruhs functional scores,were compared between the two groups.Results:The groups showed no statistically significant differences(P>0.05)in sex,age,injury side,body mass index,surgery timing,or fracture type.Group I had a significantly shorter fixation duration(25.85±5.57 weeks)compared to Group II(31.82±6.98 weeks)(P<0.05).Following fixator removal,Group I demonstrated superior Johner-Wruhs scores compared to Group II,indicating better outcomes(P<0.05).Complication rates did not differ significantly between the groups at the last follow-up(P>0.05).Conclusion:Regular postoperative ALSR testing could safely and effectively guide TSF removal following open tibial fracture treatment.This method significantly reduced fixation duration compared to traditional guidance methods while maintaining efficacy and safety.

Three predictive scores compared in a retrospective multicenter study of nonunion tibial shaft fracture

BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive scores of nonunion used in clinical practice to determine the most accurate score for predicting nonunion.METHODS We collected data from patients with tibial shaft fractures undergoing surgery from January 2016 to December 2020 in three different trauma hospitals.In this retrospective multicenter study,we considered only fractures treated with intramedullary nailing.We calculated the tibia FRACTure prediction healING days(FRACTING)score,Nonunion Risk Determination score,and Leeds-Genoa Nonunion Index(LEG-NUI)score at the time of definitive fixation.RESULTS Of the 130 patients enrolled,89(68.4%)healed within 9 months and were classified as union.The remaining patients(n=41,31.5%)healed after more than 9 months or underwent other surgical procedures and were classified as nonunion.After calculation of the three scores,LEG-NUI and FRACTING were the most accurate at predicting healing.CONCLUSION LEG-NUI and FRACTING showed the best performances by accurately predicting union and nonunion.

Outcome of application of primary versus secondary Illizarov＇s fixator in open tibial shaft fractures

BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov's fi xator application as a treatment method for type III open tibial fractures in terms of nonunion and wound infection.METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary(n=28) and secondary(n=20).RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were signifi cantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.CONCLUSION: Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fi xation, mostly due to a signifi cantly less number of patients with a bone defect in the primary group.

Results of Dynamic Interlock Nailing in Distal Tibial Fractures

A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-articular fracture of the distal tibia. Methods: Between January 2007 and December 2013, one hundred and twelve patients of distal tibia that involved the distal 6 cm of the tibia were treated at our hospital with reamed intramedullary nailing with use of two distal interlocking screws and one proximal screw in dynamic mode. The augmentation was done with poller screws whenever it was necessary. The nailing of fibular fractures was done in 27 cases. There were 85 males and 27 females with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas 32 were grade 1 open fractures. Results: The average time to union of the closed fracture was 15.4 weeks (range: 12 – 28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 (range: 15 - 34 weeks). After minimum follow-up of one year, rate of primary union was in 97.32%. One case of broken nail required revision surgery. There were three cases of delayed union and two cases of non union. In one case there was deep infection which required exchange nailing with antibiotic impregnated nail. There was breakage of interlocking screws in three cases but fracture had united. In twenty two cases acceptable malalignment of the tibia was observed after union. The outcome was determined at a minimum of one year in our study based on the criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent results, 29 had good results and 4 had fair results. Conclusions: The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures.

Return to sport following tibial plateau fractures: A systematic review

AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.

Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure

AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

Locking compression plate+T-type steel plate for postoperative weight bearing and functional recovery in complex tibial plateau fractures

Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.

Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

The Application and Operation-Effect Analysis for Complex Tibial Plateau Fractures with 3D Printing Technique

Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.

Artificial Intelligence to Diagnose Tibial Plateau Fractures: An Intelligent Assistant for Orthopedic Physicians

Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.

Treatment of Complex Proximal Tibial Fractures (Types V &VI of Schautzker Classification) by Double Plate Fixation with Single Anterior Incision

Background: complex proximal tibial fractures (Types V & VI of Schautzker classification) are the major problems in orthopedic surgery and associated with high complication rates. There are many alternatives in treatment of these fractures. Aim: to evaluate the results of double plating with single anterior incision in complex proximal tibial fractures (Types V& VI of Schautzker classification).Methods and Materials: 22 patients (16 males and 6 females) with Types V and VI of Schautzker classification of proximal tibial fractures (14 cases were Type V and 8 cases were Type VI) were treated by double plating with single anterior incision method between May 2006 and May 2011. The bony and functional outcome was evaluated according to Knee Society Score. Results: According to Knee Society Score, the results were as follows: excellent in 19 patients (86.4%), good in 2 patients (9.1%), fair in 1 patient (4/5%), and poor in no patient (0%).Conclusion: the double plate fixation with single anterior incision is the best, effective and simple procedure in treatment of complex proximal tibial fractures (Types V and VI of Schautzker classification).

Management of Tibial Metaphyseal Fractures by Hybrid External Fixator

Introduction: The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

Combined Use of Percutaneous Canulated Screws and External or Internal Fixation for Less Invasive Treatment of Tibial Plateaux Fractures

The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.

Biomechanical Comparison of Gourd-shaped LCP versus LCP for Fixation of Comminuted Tibial Shaft Fracture

The purpose of this study was to compare monotonic biomechanical properties of gourd-shaped LCP fixation with LCP fixation of human tibial shaft in gap fracture mode. Twenty paired fresh cadaveric human tibias were randomly divided into 4 groups （5 pairs each）： （1） axial loading sin- gle cycle to failure testing, （2） torsion single cycle to failure testing, （3） 4-point bending single cycle to failure testing, and （4） dynamic 4-point bending testing. A 7-hole 4.5 mm gourd-shaped LCP was se- cured on the anteromedial surface of 1 randomly selected bone from each pair, respectively, using 6 locking screws in the 1st, 2nd, 3rd, 5th, 6th and 7th hole with the middle hole unfilled and just located at the mid-diaphysis of the tibia. A 7-hole 4.5 mm LCP was secured on the other bone with the same method. Standard AO/ASIF techniques were used. After fixation finished, a 10 mm gap in the mid-diaphysis of tibia was created, centrally located at the unfilled hole. The axial, torsional, and bending stiffness and failure strengths were calculated from the collected data in static testings and statisti- cally compared using paired Student＇s t-test. The 4-point bending fatigue lives of the two constructs were calculated from the dynamic testing data and also statistically compared using paired Student＇s t-test. Failure modes were recorded and visually analyzed. P〈0.05 was considered significant. Results showed that the axial, torsional and bending stiffness of gourd-shaped LCP construct was greater （4%, 19%, 12%, respectively, P〈0.05） than that of the LCP construct, and the axial, torsional and bending failure strengths of gourd-shaped LCP construct were stronger （10%, 46%, 29%, respectively, P〈0.05） than those of the LCP construct. Both constructs failed as a result of plate plastic torsional deformation. After axial loading and 4-point bending testings, LCP failed in term of an obvious deformation of bent apex just at the unfilled plate hole, while the gourd-shaped LCP failed in term of a deformation of bent arc between the 3rd and 5th holes, which indicated a more consistent stress distribution on gourd-shaped LCP. Fatigue life of gourd-shaped LCP construct was significantly greater than LCP construct （153 836±2 228 vs. 132 471±6 460 cycles, P〈0.01）. All constructs failed as a result of fracture of the plate through the compression hole of the unfilled combination screw hole. The biomechanical testing showed that gourd-shaped LCP can provide greater stiffness and strength, and longer fatigue life than LCP. The gourd-shaped LCP may be more advantageous mechanically and may reduce the plate breakage rate clinically.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

BACKGROUND Tibial plateau fracture is one of the common fracture types.It occurs mainly in teenagers and is usually caused by a fall.After the occurrence of fracture,knee swelling,pain,limited activity,etc.greatly affect the patient’s exercise habits and lifestyle.X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were used in this examination.X-rays are relatively new and easy to operate.However,there are some errors in the observation of fracture collapse and fracture displacement.In recent years,CT and MRI have been actively used to diagnose various types of clinical fractures.They have more diagnostic power than X-ray film.However,some scholars believe that CT is also prone to errors in clinical application.The volume effect leads to missed diagnosis and misdiagnosis in some cases,while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT.To facilitate the selection of clinical examination regimens,this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included.All patients were examined by nuclear MRI and CT scanning.The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects:fracture displacement,bone defect,fracture site and fracture comminution.There was no significant difference in the score data(P>0.05).Nuclear magnetic resonance and CT tended to be consistent in the B3,C2 and C3 fracture diagnosis coincidence rate,combined injury detection rate and fracture detection rate.The diagnostic coincidence rate of type B1,B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT(P>0.05).CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures,but MRI is more accurate and may be preferred.

Exclusive Fibula Osteosynthesis for Treating Open Fractures Gustillo I-III B of the Distal Half of the Leg Bones in a Resources-Limited Setting

Introduction: Management of open leg bones fractures is a challenging health issue for the surgeon, particularly true in resource-limited settings. In this study, we evaluate exclusive fibular osteosynthesis in the treatment of open fractures of the distal half of the leg bones as a therapeutic option in our context. Methods: This is a prospective, experimental, multicenter study of 30 open fractures of the distal half of the leg bones treated with exclusive fibula osteosynthesis, conducted in 3 hospitals in the DRC from January 1, 2013 to September 30, 2016. Results: The age range of 20 to 40 years grouped 22 (73.4%) patients, the sex ratio was 1:1 and the unemployed were the most involved with 16 (53.3%) cases. The Gustilo II, I, III B and III A types represented 40%, 33.3%, 20% and 6.7%, respectively. The fractures were located in the distal third in 12 (40%) cases, in the middle third in 11 (36.7%) cases, and in both malleoli in 7 cases (23.3%). Osteosynthesis of the fibula by screw plate was applied in 22 (73.3%) patients and pinning in 8 (26.7%). Satisfactory reduction of the tibial fracture site was achieved in 29 (96.7%) cases and 100% bone healing was achieved within an average of 10 weeks. Four (13.3%) loss of alignment, 1 (3.3%) infection, 1 (3.3%) skin necrosis and 2 (6.7%) ankle stiffness complicated our fractures. Conclusion: Exclusive osteosynthesis of the fibula as a common technique for fractures of the distal half of the leg bones allowed us to reduce, immobilize and consolidate the tibial fracture in the required time and to preserve the mobility of the ankle.

Early complications of preoperative external traction fixation in the staged treatment of tibial fractures:A series of 402 cases

BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator;the time taked to treat the ankle associated lesions;the time of skin healing;the ankle alignment;the subjective/objective Ovadia and Beals score;and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion:Pilon fractures are complex and often present complications;the damage control treatment, in emergency, with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

Imaging Review of Adolescent Tibial Tuberosity Fractures

Adolescent tibial tuberosity injuries are infrequent fractures usually seen in physically active adolescent males. Powerful contraction of the knee extensors by sudden acceleration or deceleration of the quadriceps muscle can result in avulsion fractures of the tibial tuberosity apophysis. In late puberty, as the growth plate closes, it is transiently replaced by fibrocartilaginous elements. This transition causes a period of weakened tensile strength, which predisposes the tibial tuberosity to traction injury. Classification of tibial tuberosity fractures includes types I-V with added A and B subsets to types I, II and III. Multidetector computed tomography (MDCT) is a useful tool to more accurately classify complex, higher grade adolescent tibial tuberosity avulsion fractures when compared to plain film. This aids in preoperative planning and, therefore, results in improved treatment and management.