Open tibial fractures typically occur as a consequence of high energy trauma in patients of working age resulting in high rates of deep infection and poor functional outcome. Whilst improved rates of limb salvage, avoidance of infection and better ultimate function have been attributed to improved centralisation of care in orthoplastic units, there remains no universally accepted method of definitive management of these injuries. The aim of this study is to the report the experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open fractures A prospectively maintained database was interrogated to identify all patients. Case notes and radiographs were reviewed to collate patient demographics and injury factors . The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventionsIntroduction
Materials & Methods
The purpose of the study was to retrospectively assess the patients treated to date with the vac ulta system using a technique of antibiotic instillation. The vac ulta system is licensed for use with anti-septic instillation fluid but we have now treated a number of patients with antibiotic instillation under the guidance of the microbiology department. All patients being treated with the vac ulta system were included in the study. There were no exclusions. Pathology treated, infecting organism, antibiotic used and length of treatment were all recorded. Any antibiotic related complications were noted. Treatment was judged successful with resolution of presenting symptoms, normalization of inflammatory markers and three negative foam cultures. There were 21 patients included in the study. There were 13 male and 8 female patients. Length of treatment ranged from 1 week to 10 weeks with a mean of 4.2 weeks. Follow up ranged from 1 month to 42 months with a mean follow up of 17.9 months The most common pathogen was Staph. Aureus(11 cases). Enterobacter, ESBL, Strep. Milleri, MRSA and Citrobacter were also treated. Antibiotics instilled included flucloxacillin, meropenem, gentamicin, vancomycin, meropenem and teicoplanin. There were no antibiotic reactions/allergies. Pathologies treated included osteomyelitis, two stage amputations for infection, infected non-union and infected metalwork. Infection recurred in 2 of 21 patients (10%), with one recurring at 18 months and one at 2 years. The 90% treatment success rate is highly encouraging in this notoriously difficult group of patients to treat. In this series vac instill was an effective treatment of infection and allows antibiotic treatment to be targeted to the infected tissues. There were no adverse reactions seen. Larger series with longer follow up are no needed but we believe this technique is safe, successful and easily administered can be cautiously adopted on a wider basis.
The aim of the study is to evaluate how patients over 65 years of age cope with the Ilizarov method of treatment, compared with patients a decade younger. Two age groups were selected, 50–65 years versus 65 years and over. 20 consecutive patients were recruited for each group. SF36 scores were completed pre-operatively, at 6 weeks post op and 6 weeks post frame removal. 41 patients were recruited in total. Seven patients were lost to follow up – 2 died, 2 became too ill to continue with treatment, 3 did not complete the SF36. This left 34 patients. T test was used to analyse the results. Both age groups showed an equal and statistically significant drop in SF36 scores whilst the Ilizarov frame was on (p<0.01 for each group). After frame removal, SF36 in the >65 group was not significantly different to pre-operative values. In the younger group, SF36 after frame removal was still significantly lower than pre-operative values (p<0.01). Age makes no difference in how patients cope with the ilizarov frame during treatment. Older patients have low pre-injury function levels, but appear to return to this level quickly after frame removal. Younger patients do not recover pre-injury function in 6 weeks after completion of treatment.
We intended to determine our rates of deep infection and non-union in severe open tibial fractures treated at our institution with Ilizarov frames. We retrospectively reviewed the case notes and radiographs of sixty consecutive cases of severe (Gustillo-Anderson Grade III) open fractures of the tibia treated in our tertiary referral unit with the ‘Flap and Frame’ technique. This technique involves early aggressive soft tissue and bone debridement and temporary skeletal stabilisation, followed by soft tissue coverage and then, when the soft tissues have settled, definitive skeletal stabilisation with the Ilizarov frame. The primary outcome measures were the presence of deep infection, occurence of union with the index frame, and any requirement for secondary amputation.Purpose of Study
Methods
To evaluate the technique of transverse debridement, acute shortening and subsequent distraction histiogenesis in the management of open tibial fractures with bone and soft tissue loss thus avoiding the need for flap coverage. We present a retrospective review of 18 patients with Gustillo grade III open tibial fractures between 2006 and 2011. Initially managed with debridement to provide bony apposition through transverse wound excision. This allowed primary wound closure without tension, or mobilization of local muscle followed by split skin graft to provide cover. Temporary mono-lateral external fixation was utilized to allow soft tissue resuscitation, followed by Ilizarov frame for definitive fracture stabilization. In some cases it was possible to apply an Ilizarov frame at the time of initial debridement. Leg length discrepancy was subsequently corrected by corticotomy and distraction histiogenesis. Union was evaluated radiologically and clinically.UK Objective
Methods
