Introduction: Open leg fracture is a diaphyseal or metaphyseal, extra-articular fracture of one or both leg bones, with communication between the fracture site and the external environment. To provide a broader contex...Introduction: Open leg fracture is a diaphyseal or metaphyseal, extra-articular fracture of one or both leg bones, with communication between the fracture site and the external environment. To provide a broader context, studies conducted globally have highlighted the significance of understanding open leg fractures due to their complex management and potential complications. Previous research in Africa and Europe provides comparative data that emphasizes regional differences in fracture types, causes, and treatment outcomes. This study aims to contribute to improving the management of theses fractures in Niger. Materials and Methods: This was a prospective, descriptive study carried out in the Traumatology-Orthopedics Department of the Zinder National Hospital, Niger, from December 8, 2020 to June 8, 2022 (18 months). We included all patients over 15 years of age in whom an open leg fracture was diagnosed and managed. Inclusion criteria focused on patients aged over 15 years with confirmed diagnoses of open leg fractures. Results: Over an 18-month period, the frequency of open leg fractures was 16.28%. There was a predominance of males (85.93% or n = 116). The average age of patients was 31.79 years. Road accidents were the primary circumstance of occurrence (93.33% or n = 126). The fracture line was simple in 74 patients (54.81%) and complex in 61 cases (45.19%). Surgically, the external fixator was used in 78 cases (57.80%). Postoperative follow-up was mostly straightforward. The main complications were infection (4 cases) and delayed consolidation (4 cases). Conclusion: Open leg fractures in adults are frequent at Zinder National Hospital. Public road accidents were the main cause of occurrence. An external fixator osteosynthesis was the most commonly used surgical option. These findings have important implications for healthcare policy, particularly in improving trauma care infrastructure and road safety initiatives in Niger. Future studies should prioritize the development of standardized treatment protocols and investigate the long-term outcomes of different surgical approaches.展开更多
BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,...According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.展开更多
Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriat...Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriate human resources, infrastructure and medical care are not readily accessible. The introduction of new devices for fracture stabilization and the development of microsurgical procedures for soft tissue reconstruction have greatly improved the management of open fractures. Patients presenting with open fractures of long bones at Kumi Orthopaedic Center are managed with the help of SIGN nail for fracture stabilization. However, long-term outcomes for patients have not been documented. Objective: The objective of this study was to determine the long term outcomes of the management of open fractures of long bones among patients with a Surgical Implant Generation Network (SIGN) nail at Kumi Orthopaedic Center (KOC). Methods: A retrospective study of 39 patients with open fractures who were managed at KOC between 2010 and 2022. Data on patients’ socio-demographic and clinical characteristics and outcomes (both physical and radiographic) was retrieved from the SIGN surgical online database of patients with over 1 year follow up period. Results: The mean age of patients was 40.3 years. The majority were male 32 (82.1%) and the commonest mechanism of injury was Road Traffic Accidents (RTA) 37 (94.9%). The majority did not have a clear record of having received antibiotics immediately after injury 29 (74.4%). However, most had a record of receiving antibiotics 1 hour before surgery 33 (84.6%). The most affected bone was the tibia 33 (84.6%). The commonest fracture type was Gustilo IIIa 18 (46.2%). On follow up;10 (25.6%) developed an infection (osteomyelitis), 6 (15.4%) did not have a union on x-ray, 4 (10.3%) had a loose screw, 1 had an implant breakage and also 1 patient had a varus deformity. However, there was no amputation recorded. Conclusion: The management of open fractures is still a major challenge in low and middle income countries like Uganda, which is still experiencing relatively high complication rates. Guidelines emphasizing the need for early antibiotic prophylaxis and faster access to surgical treatment are required for better treatment outcomes.展开更多
BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has...BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has positive value in improving patient prognosis.AIM To explore the clinical value of the negative pressure sealing drainage technique in wound healing of Gustilo IIIB and IIIC open fractures.METHODS Eighty patients with Gustilo IIIB and IIIC open fractures with skin and soft tissue injuries who were treated in the Second People’s Hospital of Dalian from March 2019 to December 2021 were selected as the research subjects.They were divided into a study group(n=40,healed with negative pressure closed drainage)and a control group(n=40,healed with conventional dressing changes)according to the variation in the healing they received.The efficacy of the clinical interventions,the variations in the regression indicators(time to wound healing,time to fracture healing,time to hospitalization),and the conversion and healing of bacterial wounds were compared 1-3 mo after the intervention.RESULTS The total effective rate of patients among the study group was 95.00%(38/40),which was notably higher than 75.00%(30/40)among the control group(P<0.05).The wound healing time,fracture healing time,and hospital stay of the patients in the study group was shorter than the control group(P<0.05).After the intervention,the negative bacterial culture at the wound site rate and wound healing rate of the patients among the study group increased compared to the control group(P<0.05).CONCLUSION Negative pressure sealing and drainage technology has a good therapeutic effect on patients with Gustilo IIIB and IIIC open fracture wounds with skin and soft tissue injury.It can notably enhance the wound healing rate and the negative rate of bacteria on the wound surface and help to speed up the recovery process of patients.展开更多
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
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 ...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.展开更多
The study evaluated functional outcomes of foot open fractures, finding satisfactory results in 89.6% of cases. It identified associated lesions, more than two fractures, and lack of rehabilitation as predictors of po...The study evaluated functional outcomes of foot open fractures, finding satisfactory results in 89.6% of cases. It identified associated lesions, more than two fractures, and lack of rehabilitation as predictors of poor outcomes. Infection rates were low, and overall quality of life scores were good at follow-up.展开更多
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.ME...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.展开更多
Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium ter...Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.展开更多
Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified techn...Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.展开更多
Objective To discuss the operative methods,timing and outcomes of severe open Pilon fractures.Methods From April 2003 to July 2008,21 patients with open Pilon fractures were admitted.All the patients were type C fract...Objective To discuss the operative methods,timing and outcomes of severe open Pilon fractures.Methods From April 2003 to July 2008,21 patients with open Pilon fractures were admitted.All the patients were type C fracture according to展开更多
Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to J...Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.展开更多
Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and th...Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.展开更多
Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fr...Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures展开更多
Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved ...Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved tissues, importance of debridement and reconsidering contamination risks will be ultimate objectives after going through this review. The controversy is still there between minimal/conservative debridement of open fracture wounds in favour of direct closure of soft tissue on the same session against generous debridement and delayed closure by more complicated choices on the reconstructive ladder to avoid infection, delayed healing, wound chronicity, limb loss and prolonged hospital stay. In the article, basic physics behind open fractures is highlighted to gain a deeper understanding of tissue viability changes and contamination risks after injury.展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction</span></b><span "="" style="line-height:1.5;"><span style="...<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction</span></b><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">: Leg fractures are the prerogative of violent trauma, which lead to pluritissular lesions, including the opening of the focus, thus worsening the prognosis. The indication of centromedullary nailing (CMN) is subject to time and trained team requirements. The aim of this work is to evaluate the results of CMN in emergency cases of open leg fractures in adults. </span><b><span style="font-family:Verdana;">Patients</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a retrospective, descriptive and analytical study from January 1, 2014 to December 31, 2018. It concerned adult patients with an open leg fracture treated by CMN in emergency at the Orthopedics-Trauma</span></span><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">tology Department of the Yalgado Ouedraogo University Hospital. During five years, 91 patients were registered. Their average age was 34.1 years with a sex ratio of 2.2. The average admission time was 1 hour 41 minutes. Cauchoix and Duparc type I open fractures predominated (64.8%). Antibiotic therapy was instituted as soon as the patient arrived. The functional results of osteosynthesis were evaluated according to the Lysholm score after an average follow-up of 48 months. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The majority of our patients (51.3%) were operated on between the 6th and 18th hour. After careful trimming of the open fracture, CMN was performed in all our patients. The average hospital stay was six days. The mean Lysholm score was 87.23 ± 11.06 with a satisfactory functional result in 81.3% of cases. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> The satisfactory results observed in 81.3% of our study testify to the reliability of the indication of CMN as specified by Dakouré </span></span><i style="line-height:1.5;"><span style="font-family:Verdana;">et</span></i><i style="line-height:1.5;"><span style="font-family:Verdana;"> al</span></i><span style="line-height:1.5;font-family:Verdana;">.</span><span "="" style="line-height:1.5;"> </span><span style="line-height:1.5;font-family:Verdana;">[4]</span><span style="line-height:1.5;"></span><span style="line-height:1.5;"></span><span "="" style="line-height:1.5;"> </span><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">in their series. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Open leg fractures are very frequent injuries and have a considerable socio-economic impact. Centromedullary nailing is a suitable solution for adequate and rapid socio-professional reintegration of the patient.展开更多
Introduction: The aim of this study is to describe the epidemiological, lesional, therapeutic and evolutionary profile of open fractures of limbs by bites of domestic donkeys. Patients and Methods: This is a prospecti...Introduction: The aim of this study is to describe the epidemiological, lesional, therapeutic and evolutionary profile of open fractures of limbs by bites of domestic donkeys. Patients and Methods: This is a prospective descriptive study over 28 months made in the Orthopedics-Traumatology department of the Tambacounda Regional Hospital in Senegal, concerning patients bitten by donkeys, resulting in an open fracture of the thoracic and pelvic limbs. Results: Twelve male patients were included. The average age was 10.50 years ± 2.60. The most common circumstance was the bite when two donkeys were separated. The thoracic limbs were the most affected by the occurrence of the arm. Cauchoix-Duparc type II and AO A2 and B2 were predominant. The essential trimming/osteosynthesis was carried out within 24 hours of the bite. Serovaccination was systematic, but on the other hand, a single dose of anti-rabies serum was administered. Pinning was the most commonly used bone synthesis. Complications were mainly infectious, followed by a case of radial nerve palsy and non-union on pins. Conclusion: The typical profile of an open donkey bite fracture is a male child/adolescent who is bitten during the separation of two fighting donkeys. The lesions are most often found in the thoracic limbs with a predominance of Cauchoix-Duparc type II and type A2 and B2 fractures of the AO, whose treatment consisted of trimming and pinning. The infectious complications of the soft tissues marked the evolution.展开更多
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 tr...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.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematom...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>展开更多
文摘Introduction: Open leg fracture is a diaphyseal or metaphyseal, extra-articular fracture of one or both leg bones, with communication between the fracture site and the external environment. To provide a broader context, studies conducted globally have highlighted the significance of understanding open leg fractures due to their complex management and potential complications. Previous research in Africa and Europe provides comparative data that emphasizes regional differences in fracture types, causes, and treatment outcomes. This study aims to contribute to improving the management of theses fractures in Niger. Materials and Methods: This was a prospective, descriptive study carried out in the Traumatology-Orthopedics Department of the Zinder National Hospital, Niger, from December 8, 2020 to June 8, 2022 (18 months). We included all patients over 15 years of age in whom an open leg fracture was diagnosed and managed. Inclusion criteria focused on patients aged over 15 years with confirmed diagnoses of open leg fractures. Results: Over an 18-month period, the frequency of open leg fractures was 16.28%. There was a predominance of males (85.93% or n = 116). The average age of patients was 31.79 years. Road accidents were the primary circumstance of occurrence (93.33% or n = 126). The fracture line was simple in 74 patients (54.81%) and complex in 61 cases (45.19%). Surgically, the external fixator was used in 78 cases (57.80%). Postoperative follow-up was mostly straightforward. The main complications were infection (4 cases) and delayed consolidation (4 cases). Conclusion: Open leg fractures in adults are frequent at Zinder National Hospital. Public road accidents were the main cause of occurrence. An external fixator osteosynthesis was the most commonly used surgical option. These findings have important implications for healthcare policy, particularly in improving trauma care infrastructure and road safety initiatives in Niger. Future studies should prioritize the development of standardized treatment protocols and investigate the long-term outcomes of different surgical approaches.
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.
文摘Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriate human resources, infrastructure and medical care are not readily accessible. The introduction of new devices for fracture stabilization and the development of microsurgical procedures for soft tissue reconstruction have greatly improved the management of open fractures. Patients presenting with open fractures of long bones at Kumi Orthopaedic Center are managed with the help of SIGN nail for fracture stabilization. However, long-term outcomes for patients have not been documented. Objective: The objective of this study was to determine the long term outcomes of the management of open fractures of long bones among patients with a Surgical Implant Generation Network (SIGN) nail at Kumi Orthopaedic Center (KOC). Methods: A retrospective study of 39 patients with open fractures who were managed at KOC between 2010 and 2022. Data on patients’ socio-demographic and clinical characteristics and outcomes (both physical and radiographic) was retrieved from the SIGN surgical online database of patients with over 1 year follow up period. Results: The mean age of patients was 40.3 years. The majority were male 32 (82.1%) and the commonest mechanism of injury was Road Traffic Accidents (RTA) 37 (94.9%). The majority did not have a clear record of having received antibiotics immediately after injury 29 (74.4%). However, most had a record of receiving antibiotics 1 hour before surgery 33 (84.6%). The most affected bone was the tibia 33 (84.6%). The commonest fracture type was Gustilo IIIa 18 (46.2%). On follow up;10 (25.6%) developed an infection (osteomyelitis), 6 (15.4%) did not have a union on x-ray, 4 (10.3%) had a loose screw, 1 had an implant breakage and also 1 patient had a varus deformity. However, there was no amputation recorded. Conclusion: The management of open fractures is still a major challenge in low and middle income countries like Uganda, which is still experiencing relatively high complication rates. Guidelines emphasizing the need for early antibiotic prophylaxis and faster access to surgical treatment are required for better treatment outcomes.
基金the Review Committee of Fuzhou Medical College of Nanchang University(Approval No.4445644).
文摘BACKGROUND Gustilo III fractures have a high incidence and are difficult to treat.Patients often experience difficulty in wound healing.Negative pressure drainage technology can help shorten wound healing time and has positive value in improving patient prognosis.AIM To explore the clinical value of the negative pressure sealing drainage technique in wound healing of Gustilo IIIB and IIIC open fractures.METHODS Eighty patients with Gustilo IIIB and IIIC open fractures with skin and soft tissue injuries who were treated in the Second People’s Hospital of Dalian from March 2019 to December 2021 were selected as the research subjects.They were divided into a study group(n=40,healed with negative pressure closed drainage)and a control group(n=40,healed with conventional dressing changes)according to the variation in the healing they received.The efficacy of the clinical interventions,the variations in the regression indicators(time to wound healing,time to fracture healing,time to hospitalization),and the conversion and healing of bacterial wounds were compared 1-3 mo after the intervention.RESULTS The total effective rate of patients among the study group was 95.00%(38/40),which was notably higher than 75.00%(30/40)among the control group(P<0.05).The wound healing time,fracture healing time,and hospital stay of the patients in the study group was shorter than the control group(P<0.05).After the intervention,the negative bacterial culture at the wound site rate and wound healing rate of the patients among the study group increased compared to the control group(P<0.05).CONCLUSION Negative pressure sealing and drainage technology has a good therapeutic effect on patients with Gustilo IIIB and IIIC open fracture wounds with skin and soft tissue injury.It can notably enhance the wound healing rate and the negative rate of bacteria on the wound surface and help to speed up the recovery process of patients.
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.
基金funding support from Natural Science Foundation Key Project of Tianjin(20JCZDJC00600)Tianjin Health Research Project(TJWJ2023QN050)+2 种基金Applied Basic Research Foundation of Tianjin(22JCQNJC00230,22JCQNJC00360)Beijing-Tianjin-Hebei Basic Research Cooperation Project(J230007/23JCZXJC00050)Tianjin Municipal Health Commission Key Discipline Specialization(TJWJ2024XK015).
文摘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.
文摘The study evaluated functional outcomes of foot open fractures, finding satisfactory results in 89.6% of cases. It identified associated lesions, more than two fractures, and lack of rehabilitation as predictors of poor outcomes. Infection rates were low, and overall quality of life scores were good at follow-up.
文摘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.
文摘Fractures of the humeral paddle, common to young adults, are most often complex, linked to violence and an increase in road accidents. The objective of our work is to evaluate our functional results, in the medium term, correlated with a review of the literature. This is a retrospective study of 63 patients, carried out in the traumatology-orthopedics department 1 of the IBN EL JAZZAR hospital in KAIROUAN, over a period of 7 years from January 2015 to December 2021. The average age of patients was 39 years (17 - 68 years). Predominantly male. The etiologies are dominated by falls and accidents on public roads. Fractures are classified according to the Müller and Allgöwer classification where type C is found in 51% of cases. All our patients undergo an olecranon osteotomy in 71% of cases. Osteosynthesis using a Lecestre plate combined with screwing or plugging is used in 84% of cases. The evolution is marked by complications observed in eight patients (16%), including two cases of sepsis, four cases of elbow stiffness (8%), one case of joint callus and one case of pseudarthrosis. Our results are evaluated according to the Mayo Elbow Performance Score, they are excellent and good in 71% of cases, average in 18% of cases and poor in 11% of cases. Fractures of the humeral paddle are fractures with a satisfactory functional prognosis, requiring ad integrum anatomical restoration and solid osteosynthesis allowing early rehabilitation of the elbow. One case of joint callus and one case of pseudarthrosis.
文摘Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.
文摘Objective To discuss the operative methods,timing and outcomes of severe open Pilon fractures.Methods From April 2003 to July 2008,21 patients with open Pilon fractures were admitted.All the patients were type C fracture according to
文摘Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.
文摘Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.
文摘Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of openpelvic fractures
文摘Understanding basic physics behind open fractures leads to a better understanding of mechanism of injury, open fractures pathophysiology and management. Explaining local changes in viability of open fracture involved tissues, importance of debridement and reconsidering contamination risks will be ultimate objectives after going through this review. The controversy is still there between minimal/conservative debridement of open fracture wounds in favour of direct closure of soft tissue on the same session against generous debridement and delayed closure by more complicated choices on the reconstructive ladder to avoid infection, delayed healing, wound chronicity, limb loss and prolonged hospital stay. In the article, basic physics behind open fractures is highlighted to gain a deeper understanding of tissue viability changes and contamination risks after injury.
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction</span></b><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">: Leg fractures are the prerogative of violent trauma, which lead to pluritissular lesions, including the opening of the focus, thus worsening the prognosis. The indication of centromedullary nailing (CMN) is subject to time and trained team requirements. The aim of this work is to evaluate the results of CMN in emergency cases of open leg fractures in adults. </span><b><span style="font-family:Verdana;">Patients</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a retrospective, descriptive and analytical study from January 1, 2014 to December 31, 2018. It concerned adult patients with an open leg fracture treated by CMN in emergency at the Orthopedics-Trauma</span></span><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">tology Department of the Yalgado Ouedraogo University Hospital. During five years, 91 patients were registered. Their average age was 34.1 years with a sex ratio of 2.2. The average admission time was 1 hour 41 minutes. Cauchoix and Duparc type I open fractures predominated (64.8%). Antibiotic therapy was instituted as soon as the patient arrived. The functional results of osteosynthesis were evaluated according to the Lysholm score after an average follow-up of 48 months. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The majority of our patients (51.3%) were operated on between the 6th and 18th hour. After careful trimming of the open fracture, CMN was performed in all our patients. The average hospital stay was six days. The mean Lysholm score was 87.23 ± 11.06 with a satisfactory functional result in 81.3% of cases. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> The satisfactory results observed in 81.3% of our study testify to the reliability of the indication of CMN as specified by Dakouré </span></span><i style="line-height:1.5;"><span style="font-family:Verdana;">et</span></i><i style="line-height:1.5;"><span style="font-family:Verdana;"> al</span></i><span style="line-height:1.5;font-family:Verdana;">.</span><span "="" style="line-height:1.5;"> </span><span style="line-height:1.5;font-family:Verdana;">[4]</span><span style="line-height:1.5;"></span><span style="line-height:1.5;"></span><span "="" style="line-height:1.5;"> </span><span "="" style="line-height:1.5;"><span style="font-family:Verdana;">in their series. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Open leg fractures are very frequent injuries and have a considerable socio-economic impact. Centromedullary nailing is a suitable solution for adequate and rapid socio-professional reintegration of the patient.
文摘Introduction: The aim of this study is to describe the epidemiological, lesional, therapeutic and evolutionary profile of open fractures of limbs by bites of domestic donkeys. Patients and Methods: This is a prospective descriptive study over 28 months made in the Orthopedics-Traumatology department of the Tambacounda Regional Hospital in Senegal, concerning patients bitten by donkeys, resulting in an open fracture of the thoracic and pelvic limbs. Results: Twelve male patients were included. The average age was 10.50 years ± 2.60. The most common circumstance was the bite when two donkeys were separated. The thoracic limbs were the most affected by the occurrence of the arm. Cauchoix-Duparc type II and AO A2 and B2 were predominant. The essential trimming/osteosynthesis was carried out within 24 hours of the bite. Serovaccination was systematic, but on the other hand, a single dose of anti-rabies serum was administered. Pinning was the most commonly used bone synthesis. Complications were mainly infectious, followed by a case of radial nerve palsy and non-union on pins. Conclusion: The typical profile of an open donkey bite fracture is a male child/adolescent who is bitten during the separation of two fighting donkeys. The lesions are most often found in the thoracic limbs with a predominance of Cauchoix-Duparc type II and type A2 and B2 fractures of the AO, whose treatment consisted of trimming and pinning. The infectious complications of the soft tissues marked the evolution.
文摘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.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>
