scholarly journals Comparison study of compound fractures of tibial shaft treated by titanium and stainless steel interlocking nails

2017 ◽  
Vol 3 (3) ◽  
pp. 390 ◽  
Author(s):  
Pratik J. Vinchhi ◽  
Sharvil H. Gajjar ◽  
Tirth Vyas ◽  
Yatin Patel
Keyword(s):  
Stainless Steel ◽  
Functional Results ◽  
Tibial Fractures ◽  
Non Union ◽  
Interlocking Nail ◽  
Open Tibial Fractures ◽  
Screw Breakage ◽  
Compound Fractures ◽  
Solid Titanium ◽  
Tibia Shaft

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The purpose of the present study was to compare the outcomes of compound fractures of tibia shaft managed by Solid Titanium and Stainless Steel interlocking intramedullary nailing.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a retrospective study of 45 patients with 45 open fractures of tibia shaft operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In Our Study we had 45 patients with 45 open tibial fractures. All were male. 35 patients were from 20-50 years age group. Mean age was 36.4 years. In this study of 45 open tibial fractures following strict protocol of thorough debridement, primary wound closure and Solid Titanium or stainless steel interlocking nailing; it was observed at final follow up that patients operated by titanium nail compared to stainless steel had 6.45% vs. 14.29% infection rate, 12.9% vs. 21.89% rate of non-union and 3.22% vs. 7.14% screw breakage rate. According to modified ketenjian’s criteria in our study out of 31 patients operated by Titanium interlocking nail 17 (54.84%) excellent, 10 (32.26%) Good, 3(9.68%) fair and 1(3.22%) poor functional results while out of 14 patients managed by stainless steel nail 8 (57.14%) excellent, 3 (21.43%) good, 1 (7.14%) fair and 2 (14.28%) poor functional results. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In open tibial fractures titanium interlocking implants offer lower complication rate as compared to stainless steel implants and better overall patient outcome.</span></p>

scholarly journals A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

2021 ◽  
Vol 8 (15) ◽  
pp. 932-938
Author(s):  
Avinash Gundavarapu ◽  
Vishal Singh ◽  
Prashant Kumar Mishra ◽  
Santhosh Kumar M
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Functional Results ◽  
High Energy ◽  
Tibial Fractures ◽  
Bony Union ◽  
Ilizarov External Fixator ◽  
Non Union ◽  
Ring Fixator ◽  
Study Results

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

scholarly journals How common are vascular injuries in open tibial fractures? A prospective longitudinal cohort study

2019 ◽  
Vol 29 (5) ◽  
pp. 1119-1124 ◽  
Author(s):  
O. O’Malley ◽  
A. J. Trompeter ◽  
S. Krishnanandan ◽  
M. Vesely ◽  
P. Holt ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Bone Fractures ◽  
Tibial Fractures ◽  
Long Bone ◽  
Vascular Injuries ◽  
Vascular Intervention ◽  
Non Union ◽  
Open Tibial Fractures ◽  
Increased Risk ◽  
Prospective Longitudinal

Abstract Background Tibial fractures have an incidence of 15% of all adult fractures. They have been shown to have the highest incidence of non-union in long bone fractures and the highest incidence of vascular injury. Evidence from the literature suggests that a good vascular supply is important to ensure bone union. The aim of our study was to prospectively assess the incidence of vascular injuries in open tibial fractures and determine whether they were associated with an increased risk of non-union. Methods We performed a prospective study to investigate the incidence of arterial injuries with computed tomography angiography (CTA) in patients with Gustilo–Anderson grade I–III open tibial fractures between 2013 and 2015. CTA was performed with the trauma series at acute admission and reported by two independent musculoskeletal radiologists. Patients were followed up with clinical and radiographic assessment for 1 year. Results We recruited 77 patients into the study, and 56 patients (47 males, 9 females) were available for the final analysis, between 16 and 90 years of age. At the initial assessment, 29% had signs of arterial injury with active extravasation in 5%. The most common site of injury was in the diaphysis (87.5%), and the commonest mechanism was a road traffic accident. We found no significant relation between occult vascular injury and non-union (p > 0.05). Conclusion The incidence of vascular injury in open tibial fractures is 29%, and CTA is therefore a useful test in identifying vascular injuries that may require vascular intervention.

scholarly journals The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1017
Author(s):  
Marios Nicolaides ◽  
Alexandros Vris ◽  
Nima Heidari ◽  
Peter Bates ◽  
Georgios Pafitanis
Keyword(s):  
Systematic Review ◽  
Infection Rate ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Tibial Fractures ◽  
Surgical Debridement ◽  
Union Rate ◽  
Non Union ◽  
Open Tibial Fractures ◽  
Study Characteristics

Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients’ lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures. Materials and Methods: We performed a systematic review and meta-analysis of the literature to capture studies evaluating the association between timing of initial surgical debridement and infection or non-union, or other reported outcomes. We searched the MEDLINE, PubMed Central, EMBASE, SCOPUS, Cochrane Central and Web of Science electronic databases. Our methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane handbook for systematic reviews of interventions. Results: The systematic review included 20 studies with 10,032 open tibial fractures. The overall infection rate was 14.3% (314 out of 2193) and the overall non-union rate 14.2% (116 out of 817). We did not find any statistically significant association between delayed debridement and infection rate (OR = 0.87; 95% CI, 0.68 to 1.11; p = 0.23) or non-union rate (OR = 0.70; 95% CI, 0.42 to 1.15; p = 0.13). These findings did not change when we accounted for the effect of different time thresholds used for defining early and late debridement, nor with the Gustilo–Anderson classification or varying study characteristics. Conclusion: The findings of this meta-analysis support that delayed surgical debridement does not increase the infection or non-union rates in open tibial fracture injuries. Consequently, we propose that a reasonable delay in the initial debridement is acceptable to ensure that optimal management conditions are in place, such that the availability of surgical expertise, skilled staff and equipment are prioritised over getting to surgery rapidly. We recommend changing the standard guidance around timing for performing surgical debridement to ‘as soon as reasonably possible, once appropriate personnel and equipment are available; ideally within 24-h’.

scholarly journals Antibiotic-Coated Nail in Open Tibial Fracture: A Retrospective Case Series

2021 ◽  
Vol 6 (4) ◽  
pp. 97
Author(s):  
Carlo Perisano ◽  
Tommaso Greco ◽  
Chiara Polichetti ◽  
Michele Inverso ◽  
Giulio Maccauro
Keyword(s):  
Fracture Healing ◽  
Case Series ◽  
Fracture Site ◽  
Tibial Fractures ◽  
Retrospective Case ◽  
Non Union ◽  
Open Tibial Fractures ◽  
Local Antibiotic

Implant-associated infections still represent one of the main problems in treatment of open fracture. The role of systemic antibiotic prophylaxis is now agreed and accepted; however, recent literature seems to underline the importance of local antibiotic therapy at the fracture site, and antibiotic nails have been shown to play a role in the treatment of open fractures in terms of fracture healing and lower risk of infection. We retrospectively analyzed our results, from January 2016 to March 2020, with the use of coated nails in the treatment of open tibial fractures, evaluating the rates of infection and fracture healing as primary outcomes and the rate of reoperations, time from trauma to nailing and hospital stay as secondary outcomes. Thirty-eight patients treated with coated nail (ETN ProtectTM, Synthes) were included in the study. Minimum follow-up was of 18 months. Thirty-four of 38 patients achieved bone union and 2 patients underwent septic non-union. In our series, no systemic toxicity or local hypersensitivity to antibiotics were recorded. From this study, use of antibiotic-coated nails appears to be a valid and safe option for treatment of open tibial fractures and prevention of implant-related infections, particularly in tibial fractures with severe soft tissue exposure and impairment.

scholarly journals Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases

2017 ◽  
Vol 4 (1) ◽  
pp. 65
Author(s):  
Neetin P. Mahajan ◽  
Eknath D. Pawar ◽  
Amit C. Supe ◽  
Hitesh J. Mangukiya
Keyword(s):  
Storage System ◽  
Distal Tibia ◽  
Delayed Union ◽  
P Value ◽  
Non Union ◽  
Interlocking Nail ◽  
Screw Breakage ◽  
Diaphyseal Fractures

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal tibial diaphyseal fractures are </span><span lang="EN-IN">known for its various challenges that orthopaedicians face while treating. While performing surgery, many principles of fixations are needed to be properly addressed. This study was undertaken to know the efficiency of closed reduction, polar screws and tibia interlocking nail fixation at our Institute.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The data, which were collected from the medical records and Department digitalised storage system and from the HMIS patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and AO classification of distal tibial fracture admitted in Orthopaedics Department from 2007 to 2013. Analyses of 46 cases, 34 males and 12 females, were made to find out the functional, radiological outcome, associated complications in treating distal tibia with ILN. During Analysis, association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P value of &lt;0.05 was considered significant</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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 weeks (range: 15-34 weeks). Complications of delayed union occurred in 3 cases, and two cases of non-union. Infection in 6 cases (5 superficial, 1 deep), screw breakage in 4 cases and 3 cases of significant malalignment. The final functional outcome of 33 patients had excellent results, 11 had good results and 2 had fair results as determined by criteria of Johner and Wruh</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

scholarly journals External fixation in the treatment of open tibial shaft fractures

2008 ◽  
Vol 65 (5) ◽  
pp. 343-348 ◽  
Author(s):  
Zoran Golubovic ◽  
Predrag Stojiljkovic ◽  
Lana Macukanovic-Golubovic ◽  
Dragan Milic ◽  
Sasa Milenkovic ◽  
...  
Keyword(s):  
External Fixation ◽  
Tibial Fracture ◽  
Tibial Fractures ◽  
Open Tibial Fractures ◽  
Shaft Fractures ◽  
Tibia Shaft Fractures ◽  
The Mean ◽  
Pin Track ◽  
Tibia Shaft ◽  
Tibial Shaft Fractures

Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). Ther were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). Conclusion. Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.

Non-union in open tibial fractures

1977 ◽  
Vol 59 (2) ◽  
pp. 244-248 ◽  
Author(s):  
RE Rosenthal ◽  
JA MacPhail ◽  
JE Oritz
Keyword(s):  
Tibial Fractures ◽  
Non Union ◽  
Open Tibial Fractures
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