There are multiple risk factors regarding the outcome of open tibia fractures treated with surgical fixation. In this study we have looked at delay to debridement and HIV infection as risk factors in the outcome of open tibia fractures. We present a prospective study of 89 patients with open tibia fractures treated with surgical fixation with a significant delay to first debridement and a high prevalence of HIV infection. Primary outcome of this study was time to union and wound infection in the first 3 months. All patients admitted in our hospital between February 2011 and October 2012 with open fractures of the tibia requiring surgical fixation were included in the study. Patients were tested for HIV infection and multiple clinical parameters were documented, including; Gustilo-Anderson classification, ASEPSIS wound score, New Injury Severity Score(NISS), comorbidities, time to 1st debridement, time to 1st dose of antibiotics, pin site score, level of contamination, level training of the surgeon, high energy injuries, time to union and socio-economic parameters. Patients were followed to union.Background:
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A high volume of trauma and limited resources means that traditional methods of bone reconstruction are not feasible in parts of Africa. We present the management and outcomes of using Masquelet's concept, of an induced membrane and secondary morcellised cancellous bone grafting, in patients with severe lower limb trauma. Eleven patients were treated in an orthopaedic department in rural southern Africa between 2011 and 2012. This is a subgroup that is part of a larger study of open fractures that received ethical approval. All patients were male, with ten aged between 20 and 35 and one aged 70. Two were HIV positive. There were three open femur and eight open tibia fractures. Three required fasciocutaneous flaps and one required a muscle flap to achieve adequate soft tissue coverage. Eight cases were performed as the primary treatment and three were to treat septic non-unions. Bone defects ranged from 4 to 10 cm. Definitive bony stabilisation was maintained by mono-lateral external fixator in three patients. In other cases this was converted to a circular frame or internal fixation. The results have been mixed. In three patients bone grafting was delayed due to wound or pin site problems. In one case the bone graft was lost due to infection but repeating the procedure produced a good result. Time to bony union in each case is difficult to quantify. However, there is clear evidence of new bone forming in most cases. Four patients are weight bearing with external fixation removed, as are five patients with internal fixation. In a few cases bony union appears to be taking significantly longer, if at all. Masquelet technique is a welcome addition to the options available in bone reconstruction. However, time to achieve bony union is unpredictable. Refinement of the technique for use in the developing world is needed.
In 2011 Aird et al published their results of the effects of HIV on early wound healing in open fractures treated with internal and external fixation. The study was conducted between May 2008 and March 2009 and performed in semi-rural area of KwaZulu-Natal, South Africa. These results suggested that HIV is not a contraindication to internal or external fixation of open fractures, as HIV is not a significant risk factor for acute wound implant infection. We present a longer term follow up of this same cohort of patients from the original study. From March 2011 to January 2012 we attempted to contact all patients from Airds original study. A simple telephonic questionnaire was obtained from all the patients contacted, regarding possible late sepsis, non-union and implant removal. Patients were requested to visit the outpatient department for a clinical assessment, a repeat HIV test and new X-rays.Background
Methods
A recent retrospective study of distal femoral physeal fractures (DFPFs) suggested closed manipulation alone has a high incidence of re-displacement, malunion or physeal bar formation. The paper concluded that all displaced DFPFs require internal fixation, and breaching the physis with k-wires is safe. We agree that hyper-extension/flexion injuries need stabilisation using k-wires but, in our experience, purely valgus/varus deformities can be successfully managed by manipulation under anaesthesia (MUA) and a moulded cylinder cast. We prospectively observed DFPFs presenting over 12 months. Departmental policy is to treat varus/valgus deformities by MUA, with cylinder casting providing 3 point fixation. Hyper-extension/flexion injuries are reduced on a traction table. 2mm cross k-wiring is performed, leaving the wires under the skin, and a cylinder plaster applied. A post-operative CT scanogram accurately assesses limb alignment. Patients are mobilised immediately using crutches and weight-bearing as pain allows. Plaster and k-wires are removed after 4–5 weeks. Scanogram is then repeated, and again at 6 months and 1 year.Introduction
Method
To assess the long term functional and objective outcomes for 2 stage Dupuytrens contracture correction. Patients with severe contracture were offered a 2 stage correction. This involved application of external fixator to distract the contracture over the course of 2 weeks and subsequent partial fasciectomy (in primary contractures) and dermofasciectomy with full thickness skin graft (in recurrent contractures). A series of 54 corrections in 47 patients were identified. Of these, 6 were lost to follow-up, 1 deceased. Pre-operative total range of active movement (TRAM), total flexion contracture and PIP flexion contracture, Tubiana grade and DASH/Michigan Hand Scores were recorded and compared to post-operative data.Objective
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