BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours...BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.展开更多
The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s ...The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s shaft fracture of tibia and fibula had been treated by ESIN. 15 cases were followed up after the surgery and the follow-up time was 4 - 12 months (4.5 in average). The results turn out that all the patients’ fractures have got healed by Phase I and the healing time is 10 weeks in average. The near joints’ activity and affected extremity completely return to normal. This group of cases doesn’t show any sign of infection, bone nonunion, malunion or epiphysis injury. And six patients have had their intramedullary nails taken out after six months. It can be concluded that ESIN is good for treating children’s long diaphysis fracture which has difficulty in closed diaplasis and is suitable for children aged 6 - 13. ESIN has the advantages of small incision, slight injury of soft tissue, short sur-gery time, rapid recovery and few complications.展开更多
BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with min...BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.展开更多
Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a si...Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.展开更多
Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice f...Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice for treating tibia shaft fractures.To improve the delivery of antibiotics at the tissue-implant interface,many methods have been proposed as a part of prophylaxis against infection.This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking(IMIL)nail in the prevention of infection in Gustilo typeⅠandⅡopen tibia fractures and to compare the results with regular intramedullary nail.Methods:The study included 28 patients with open tibia fractures(Gustilo type 1 or type 2);of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing.Randomization was done by alternate allocation of the patients.Follow-up was done postoperatively(day 1),1 week,6 weeks,and 6 months for bone union,erythrocyte sedimentation rate(ESR),hemoglobin and C?reactive protein(CRP).Statistical significance was tested using unpaired t-test.A p value less than 0.05 was considered significant.Results:There were 4 cases of infection in controls(regular IMIL nail)and no infection among patients treated with gentamicin-coated nail during the follow up(Х^2=4.66,p=0.031).At 6 months postoperatively,CRP(p=0.031),ESR(p=0.046)and hemoglobin level(p=0.016)showed significant difference between two groups.The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up(p=0.016).Conclusion:Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo typeⅠandⅡopen tibia fractures.展开更多
文摘BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.
文摘The Objective is to evaluate Elastic Stable Intrame-dullary Nailing (ESIN) fixation through the treat-ment of children’s shaft fracture of tibia and fibula. From January 2007 to January 2009, 16 cases of children’s shaft fracture of tibia and fibula had been treated by ESIN. 15 cases were followed up after the surgery and the follow-up time was 4 - 12 months (4.5 in average). The results turn out that all the patients’ fractures have got healed by Phase I and the healing time is 10 weeks in average. The near joints’ activity and affected extremity completely return to normal. This group of cases doesn’t show any sign of infection, bone nonunion, malunion or epiphysis injury. And six patients have had their intramedullary nails taken out after six months. It can be concluded that ESIN is good for treating children’s long diaphysis fracture which has difficulty in closed diaplasis and is suitable for children aged 6 - 13. ESIN has the advantages of small incision, slight injury of soft tissue, short sur-gery time, rapid recovery and few complications.
文摘BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.
文摘Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type;multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.
文摘Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice for treating tibia shaft fractures.To improve the delivery of antibiotics at the tissue-implant interface,many methods have been proposed as a part of prophylaxis against infection.This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking(IMIL)nail in the prevention of infection in Gustilo typeⅠandⅡopen tibia fractures and to compare the results with regular intramedullary nail.Methods:The study included 28 patients with open tibia fractures(Gustilo type 1 or type 2);of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing.Randomization was done by alternate allocation of the patients.Follow-up was done postoperatively(day 1),1 week,6 weeks,and 6 months for bone union,erythrocyte sedimentation rate(ESR),hemoglobin and C?reactive protein(CRP).Statistical significance was tested using unpaired t-test.A p value less than 0.05 was considered significant.Results:There were 4 cases of infection in controls(regular IMIL nail)and no infection among patients treated with gentamicin-coated nail during the follow up(Х^2=4.66,p=0.031).At 6 months postoperatively,CRP(p=0.031),ESR(p=0.046)and hemoglobin level(p=0.016)showed significant difference between two groups.The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up(p=0.016).Conclusion:Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo typeⅠandⅡopen tibia fractures.
