To compare results of institutional preferences with regard to treatment of soft tissues in the setting of open tibial shaft fractures. We present a retrospective review of open tibial shaft fractures at two high-volume level 1 trauma centres with differing practices with regard to the acute management of soft tissues. Site 1 attempts acute primary closure, while site 2 prefers delayed closure/coverage. Comparisons include percentage of primary closure, number of surgical procedures until definitive closure, percentage requiring soft tissue coverage, and percentage of 90-day wound complication.Aims
Methods
We present our experience of managing patients
with iatropathic brachial plexus injury after delayed fixation of
a fracture of the clavicle. It is a retrospective cohort study of
patients treated at our peripheral nerve injury unit and a single
illustrative case report. We identified 21 patients in whom a brachial
plexus injury occurred as a direct consequence of fixation of a
fracture of the clavicle between September 2000 and September 2011. The predominant injury involved the C5/C6 nerves, upper trunk,
lateral cord and the suprascapular nerve. In all patients, the injured
nerve was found to be tethered to the under surface of the clavicle
by scar tissue at the site of the fracture and was usually associated
with pathognomonic neuropathic pain and paralysis. Delayed fixation of a fracture of the clavicle, especially between
two and four weeks after injury, can result in iatropathic brachial
plexus injury. The risk can be reduced by thorough release of the
tissues from the inferior surface of the clavicle before mobilisation
of the fracture fragments. If features of nerve damage appear post-operatively
urgent specialist referral is recommended. Cite this article:
The aim of this retrospective study was to review a series of patients with ipsilateral fractures of the neck of the scapula and of the clavicle. Between 1991 and 1996 a total of 79
