DEFINING “IMPENDING” COMPARTMENT SYNDROME AND DEVELOPING INDIAN DISTRICT HOSPITAL PROTOCOL FOR HIGH ENERGY PROXIMAL TIBIA FRACTURES.

2021 ◽  
pp. 66-70
Author(s):  
Nirjhar Maji ◽  
Anurag Das ◽  
Kuntal Bakuli
Keyword(s):  
Soft Tissue ◽  
Compartment Syndrome ◽  
Urban Areas ◽  
Soft Tissues ◽  
Proximal Tibia ◽  
District Hospital ◽  
Initial Period ◽  
High Energy ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Background and objectives: High energy proximal tibia fractures (OTA 41/Schatzker 4/5/6) are common in motorbike accidents even in semi urban and sub-urban areas. Recommended management involves two stages with conventional Mantra of 'Span-Scan-Plan'. First stage involves temporary knee spanning external xator to prevent or manage impending compartment syndrome. This is followed by CTScan. The second stage is the denitive internal xation. These recommendations are not universally followed due to certain infrastructural and acceptability constraints inuencing decision making. Summary: The study is designed as prospective observational study. It is conducted in a District Hospital setup. An effort to dene and recognise “Impending Compartment Syndrome” is made by developing a clinical criteria based evaluation score. This score was used to monitor fracture related soft tissue changes over the initial period until denitive xation. All patients underwent temporary stabilisation by different methods. These different temporary xation methods were compared amongst each other to nd out their efcacy. Patient was assessed to the end point of where soft tissues settled down for denitive xation. Surgical site infection and knee function was assessed to nd out whether the type of temporary xation had any subsequent on soft tissue and knee joint. The results were statistically analysed to nd out clinical signicance.

Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

2009 ◽  
Vol 22 (3) ◽  
pp. 152
Author(s):  
Seung-Ryul Lee ◽  
Jae-Hoon Yang ◽  
June-Kyu Lee ◽  
Hyun-Dae Shin ◽  
Kyung-Cheon Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Proximal Tibia ◽  
High Energy ◽  
Soft Tissue Damage ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures ◽  
Severe Soft Tissue

scholarly journals Result of Ring Fixator in High-energy Schatzker Type VI Fractures of Proximal Tibia

2021 ◽  
pp. 451-459
Author(s):  
Aftab Alam Khanzada ◽  
Muhammad Rafique Joyo ◽  
Muhammad Imran Javed ◽  
Nizam Ahmed ◽  
Niaz Hussain Keerio ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Proximal Tibia ◽  
High Energy ◽  
Soft Tissue Damage ◽  
Soft Tissue Envelope ◽  
Ring Fixator ◽  
Schatzker Type ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator). Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI). Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen & Jarvinen (1992). Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed. Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures

2020 ◽  
Vol 30 (4) ◽  
pp. 671-680 ◽  
Author(s):  
Gianluca Canton ◽  
Federico Santolini ◽  
Marco Stella ◽  
Antonio Moretti ◽  
Michele Francesco Surace ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Proximal Tibia ◽  
High Energy ◽  
Septic Complications ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Staged Management of High-Energy Proximal Tibia Fractures (OTA Types 41)

2005 ◽  
Vol 19 (7) ◽  
pp. 448-455 ◽  
Author(s):  
Kenneth A Egol ◽  
Nirmal C Tejwani ◽  
Edward L Capla ◽  
Philip L Wolinsky ◽  
Kenneth J Koval
Keyword(s):  
Proximal Tibia ◽  
High Energy ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Clinical and Radiological Outcome of Complex Proximal Tibia Fractures Managed with Hybrid/Ilizarov Fixator with or without Minimal Internal Fixation

2021 ◽  
Vol 23 (4) ◽  
pp. 279-285
Author(s):  
Atmananda S. Hegde ◽  
Arkesh Madegowda ◽  
Vikrant Khanna ◽  
Seetharam Rao
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Proximal Tibia ◽  
Tertiary Care ◽  
High Grade ◽  
Tibia Fractures ◽  
Ilizarov Fixator ◽  
Proximal Tibia Fractures

Background. Complex high grade proximal tibia fractures with associated extensive soft tissue injury pose a management challenge. The timing of surgery and fracture fixation options depend upon the extent of soft tissue damage. Post-operative complications such as wound breakdown, infection and infected non-union are common in such cases managed early with open reduction and internal fixation. Such fractures can be treated with primary closed reduction and Ilizarov/hybrid fixator application. Materials and methods. It is a retrospective cross sectional study conducted at two tertiary care multispecialty hospitals to report the mid-term clinical and radiological outcomes of complex high grade proximal tibia fractures. These injuries were managed by closed reduction and external fixation with/without minimal internal fixation as a definitive procedure and outcome measures were checked with serial radiographs and functional scores at a regular interval of follow up. 17 patients with Schatzker’s type 5 or 6 proximal tibia fractures with soft tissue compromise were operated on at two tertiary care referral centres from 2017 to 2019. These cases were operated on by two experienced trauma surgeons. Periodic follow-up was done and radiological and functional progression noted from case records. Results. Average time to union was noted to be 12.59 weeks and mean time of fixator removal was 21.4 weeks. At the end of 1 year of follow-up, average range of motion was 121.76 degrees, average WOMAC score was 74.81(63-82) and KOOS score was 78.24(63-85). Conclusions. 1. Hybrid/Ilizarov fixator method is a safe way of fixing high energy proximal tibia fractures. It is associated with a good functional outcome, less soft tissue complications and allows early weight bearing. 2. We recommend this method of treatment for complex high grade proximal tibia fractures.

Acute Compartment Syndrome of Upper Extremities with Tendon Ruptures

2017 ◽  
Vol 22 (04) ◽  
pp. 411-415
Author(s):  
Taku Suzuki ◽  
Eiko Yamabe ◽  
Takuji Iwamoto ◽  
Katsuji Suzuki ◽  
Harumoto Yamada ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Compartment Syndrome ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Skin Grafting ◽  
High Energy ◽  
Acute Compartment Syndrome ◽  
Mechanism Of Injury ◽  
Sensory Disturbances

Background: It is well known that acute compartment syndrome is associated with fracture of the forearm, while involvement of soft tissue injury including musculotendinous injury remains unclear. The purpose of this study was to evaluate the soft tissue involvement, including musculotendinous ruptures, in acute compartment syndrome of the upper limb. Methods: We retrospectively enrolled 16 patients who underwent surgical treatment for acute compartment syndrome of the upper extremity. The average age of the patients was 47 years (range, 14 to 79) and the mean follow-up period after the surgery was 15 months (range, 12 to 29). Complications included at least one presentation at the final follow up of sensory disturbances or motor disturbances. We examined the presence of musculotendinous injury mechanism of injury, presence of fracture, the performance of skin grafting, and complications. Results: Mechanism of injury of “caught in a machine” was found in six cases. Three of these patients had musculotendinous ruptures and all muscle tears were revealed by intraoperative findings. No patients had muscle ruptures with other injury mechanisms. Seven out of 16 patients (44%) developed complications at final follow-up. Skin grafting was performed in six patients, and five of these patients developed complications. Only one of the nine patients without complications underwent skin grafting. Conclusions: In cases of high-energy injuries, the surgeon should suspect the presence of a musculotendinous injury prior to surgery.

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