3 research outputs found
Extra-articular distal tibia fractures—controversies regarding treatment options. A single-centre prospective comparative study
No full textSurgical treatment of distal tibia fractures with intra-medullary nail
No full textIInd Clinic of Orthopaedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Introduction.
Fractures of the distal tibia in the adult result from a combination of axial compression and rotational forces.
Surgical treatment of extra-articular fractures of distal tibia is a controversial topic throughout the entire literature. The
recent development of more distal locking options with IM nails and anatomically-contoured angle-stable plates have
improved our ability to stabilise these fractures.
Material and methods.
This study included 27 patients admitted and treated for distal extra-articular tibial fractures (AO 43 A1-3) between Jan
2012 and May 2015 in the IInd Clinic of Orthopaedics and Traumatology. Ten patients sustained open fractures (two type
I GA, four type II GA and four type IIIA GA). Nine patients also had distal peroneal or peroneal malleolus associated
fractures and 18 had associated supra-malleolar fractures of the peroneus.
IM nailing was the treatment choice for all cases (with reaming in 14 cases) and for the associated peroneal fractures ORIF
with plates and screws was performed.
Results.
From a total of 27 cases, 4 (14,8%) cases healed with a varum>5o deformity, 3 (11,1%) cases developed pseudarthrosis that
necessitated further surgical treatment (angular stable plates and bone graft), 1 (3,7%) case had intraarticular nail migration
and infection, 19 (70,4%) cases had a favourable evolution with good outcome.
All fracture healing complications appeared within the cases treated without medullary canal reaming and without associated
distal peroneal fractures.
Conclusions.
Cases treated with ORIF for distal peroneal fractures had better results that those treated by conservative means. IM nailing
can be extremely important in open fractures where it can provide excellent fixation of the fracture fragments and allows, if
necessary, extensive debridement and reconstructive treatment for soft tissues without direct implant exposure. It was also
noted that reamed nailing was biomechanically superior in terms of stability to the unreamed nails
Staged Treatment of Posttraumatic Tibial Osteomyelitis with Rib Graft and Serratus Anterior Muscle Autografts—Case Report
No full textOsteomyelitis of the tibia is a challenging condition, particularly when it occurs as a result of trauma. This abstract presents a case study detailing the successful staged treatment of posttraumatic tibial osteomyelitis utilizing a unique combination of rib graft and serratus anterior muscle. This medical abstract presents a case study of a 52-year-old male with a history of heavy smoking and obliterating arteriopathy of the lower limbs. The patient sustained a traumatic open fracture classified as Type IIIA Gustilo Anderson involving one-third of the distal right tibia diaphysis, with an associated right fibular malleolus fracture. The treatment approach comprised multiple stages, focusing on wound management, infection control, and limb salvage. The initial stage involved the application of an external fixation device in the emergency setting. Seven days later, an osteosynthesis procedure was performed using a Kuntscher nail and wire cerclage. However, complications emerged, with wound dehiscence and purulent secretion observed at 14 days postsurgery. Subsequently, secondary suturing was carried out at the 20-day mark. The second stage of the treatment involved implant removal, wide excisional debridement, pulse lavage, osteoclasia, and relaxation of the peroneal malleolus. A monoplane external fixation system was applied. As a part of postoperative care, aspiration therapy with a vacuum pump was administered, along with a 10-day course of vancomycin according to the antibiogram. Positive clinical signs of healing were noted, and sterile cultures confirmed the results. The third stage of the intervention focused on grafting the osteo-muscular defect, utilizing autografts from the rib and serratus anterior muscle. The external fixator was maintained in place during this phase. In the fourth and final stage, after an 8-week integration period of the musculocutaneous flap, the external fixator was removed, and internal fixation was accomplished with a blocked Less Invasive Stabilization System (LISS) plate inserted using the Minimally Invasive Plate Osteosynthesis (MIPO) technique. This case underscores the significance of a multistage approach in managing complex limb injuries, emphasizing the importance of timely intervention, infection control, and innovative techniques for limb salvage and restoration of function
