Characterization of patients with diaphyseal open tibial fractures at El Valle (Colombia) University Hospital
DOI:
https://doi.org/10.1016/j.rccot.2015.02.001Keywords:
open fracture, tibia, infection, antibiotics, external fixation, nailing, flap, delayed wound closure, evidence level: IVAbstract
Background: The management of open tibial fractures is controversial, as there is no single treatment guide. The aim of this study was to determine the characteristics, treatment and outcomes of this disease in the Hospital Universitario del Valle.
Material and methods: A prospective, observational study was conducted that included adult patients surgically treated between November 15, 2011 and May 15, 2012, followed-up for at least one year. The data recorded included sociodemographic characteristics, trauma, treatment, and functional and bone results.
Results: A total of 37 patients, with a mean age 35 years were included. Antibiotic therapy was given in 19% within three hours. The first surgery was performed in a mean of 20.3hours after trauma, and was not associated with the presence of infection. Stabilization with external fixation or intramedullary nailing was performed in 75% of cases, with equal effectiveness in consolidation. There was no relationship between the type of fixation and the presence of infection. Follow-up was completed by 73%, and 85% of fractures were consolidated within a mean of 39 weeks, with 85% having excellent/good bone results, and 89% with excellent/good functional results. The prevalence of infection was 7.4% and highly related to nonunion. There was no relationship between the type of fixation and the presence of infection.
Discussion: Patients will benefit from early referral to a definitive institution of treatment, the early beginning antibiotic therapy, early surgical debridement and bone stabilization, ideally with intramedullary nails though external fixation as a good choice. The infection should be treated aggressively.
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Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77:417-21. https://doi.org/10.1302/0301-620X.77B3.7744927
Melvin JS, Dombroski DG, Torbert JT, et al. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg. 2010;18:10-9. https://doi.org/10.5435/00124635-201001000-00003
Wani N, Baba A, Kangoo K, Mir M. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int Orthop. 2011 Jun;35(6):915-23. https://doi.org/10.1007/s00264-010-1023-7
Khatod M, Botte MJ, Hoyt DB, et al. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003;55:949-54. https://doi.org/10.1097/01.TA.0000092685.80435.63
Kooistra AW, Dijkman BG, Busse JW, et al. The radiographic union scale in tibial fractures: reliability and validity. J Orthop Trauma. 2010;24:S81-6. https://doi.org/10.1097/BOT.0b013e3181ca3fd1
Patzakis MJ, Wilkins J, Moore TM. Consideration in reducing the infection rate in open tibial fractures. Clin Orthop. 1983;178:36-41. https://doi.org/10.1097/00003086-198309000-00006
Sen C, Kocaoglu M, Eralp L, et al. Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss. J Orthop Trauma. 2004;18:150-7. https://doi.org/10.1097/00005131-200403000-00005
Toh CL, Jupiter JB. The infected nonunion of the tibia. Clin Orthop. 1995;315:176-91. https://doi.org/10.1097/00003086-199506000-00019
Bednar DA, Parikh J. Effect of time delay from injury to primary management on the incidence of deep infection after open fractures of the lower extremities caused by blunt trauma in adults. J Orthop Trauma. 1993;7:532-5. https://doi.org/10.1097/00005131-199312000-00008
Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, Mehta S. Open tibial shaft fractures: II. Definitive management and limb salvage. J Am Acad Orthop Surg. 2010 Feb;18(2):108-17. https://doi.org/10.5435/00124635-201002000-00005
Keating JF, O'Brien PI, Blachut PA, et al. Reamed interlocking intramedullary nailing of open fractures of the tibia. Clin Orthop Relat Res. 1997;338:182-91. https://doi.org/10.1097/00003086-199705000-00025
Patzakis MJ, Bains RS, Lee J, et al. Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, ciprofloxacin, to combination antibiotic therapy in open fracture wounds. J Orthop Trauma. 2000;14:529-33. https://doi.org/10.1097/00005131-200011000-00002
Hauser CJ, Adams CA Jr, Eachempati SR; Council of the Surgical Infection Society. Surgical Infection Society guide-line: Prophylactic antibiotic use in open fractures. An evidencebased guideline. Surg Infect (Larchmt). 2006;7:379-405. https://doi.org/10.1089/sur.2006.7.379
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989 Jun;(243):36-40. https://doi.org/10.1097/00003086-198906000-00006
Harley BJ, Beaupre LA, Jones CA, Dulai SK, Weber DW. The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma. 2002 Aug;16(7):484-90. https://doi.org/10.1097/00005131-200208000-00006
A report by the British Orthopaedic Association/British Association of Plastic Surgeons Working Party on the management of open tibial fractures: September 1997. Br J Plast Surg. 1997;50:570-83. https://doi.org/10.1016/S0007-1226(97)90501-4
Crowley DJ, Kanakaris NK, Giannoudis PV. Debridement and wound closure of open fractures: The impact of the time factor on infection rates. Injury. 2007;38:879-89. https://doi.org/10.1016/j.injury.2007.01.012
Sungaran J, Harris, Mourad M. The effect of time to theatre on infection rate for open tibia fractures. ANZ J Surg. 2007;77: 886-8. https://doi.org/10.1111/j.1445-2197.2007.04266.x
Pollak A, Jones AL, Castillo RC, et al; the LEAP Study Group. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg. 2010;92:7-15. https://doi.org/10.2106/JBJS.H.00984
Hohmann E, Tetsworth K, Radziejowski MJ, et al. Comparison of delayed and primary wound closure in the treatment of open tibial fractures. Arch Orthop Trauma Surg. 2007;127:131-6. https://doi.org/10.1007/s00402-006-0222-6
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976 Jun;58(4):453-8. https://doi.org/10.2106/00004623-197658040-00004
Singer RW, Kellam JF. Open tibial diaphyseal fractures. Clin Orthop Relat Res. 1995;315:114-8. https://doi.org/10.1097/00003086-199506000-00012
Faisham WI, Nordin S, Aidura A. Bacteriological study and its role in the management of open tibial fracture. Med J Malaysia. 2001;56:201-6.
DeLong WG Jr, Born CT, Wei SY, et al. Aggressive treatment of 119 open fracture wounds. J Trauma. 1999;46:1049-54. https://doi.org/10.1097/00005373-199906000-00012
Weitz-Marshall AD, Bosse MJ. Timing of closure of open fractures. J Am Acad Orthop Surg. 2002;10:379-84. https://doi.org/10.5435/00124635-200211000-00001
Bhandari M, Guyatt GH, Swiontowski MF. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg (Br). 2001;83B:62-8. https://doi.org/10.1302/0301-620X.83B1.0830062
Bhandari M, Guyatt GH, Tornetta P, et al. Current practice in the intramedullary nailing of tibial shaft fractures: an international survey. J Trauma. 2002;53:725-73. https://doi.org/10.1097/00005373-200210000-00018
Olson SA, Schemitsch EH. Open fractures of the tibia: an update. Instr Course Lect. 2003;52:623-31.
Ziran BH, Darowish M, Klatt BA, et al. Intramedullary nailing in open tibia fractures: a comparison of two techniques. Int Orthop. 2004;28:235-8. https://doi.org/10.1007/s00264-004-0567-9
Lee YS, Lo TY, Huang HL. Intramedullary fixation of tibial shaft fractures: a comparison of the unlocked and interlocked nail. Int Orthop. 2008;32:69-74. https://doi.org/10.1007/s00264-006-0271-z
Sen C, Kocaoglu M, Eralp L, Gulsen M, Cinar M. Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases. J Orthop Trauma. 2004 Mar;18(3):150-7. https://doi.org/10.1097/00005131-200403000-00005
Enninghorst N, McDougall D, Hunt JJ, Balogh ZJ. Open tibia fractures: timely debridement leaves injury severity as the only determinant of poor outcome. J Trauma. 2011;70: 356-7. https://doi.org/10.1097/TA.0b013e31820b4285
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742-6. https://doi.org/10.1097/00005373-198408000-00009
Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects. J Orthop Trauma. 2000 Feb;142:76-85. https://doi.org/10.1097/00005131-200002000-00002
Tripuraneni K, Ganga S, Quinn R, Gehlert R. The effect of time delay to surgical debridement of open tibia shaft fractures on infection rate. Orthopedics. 2008;31. https://doi.org/10.3928/01477447-20081201-27
Doucet JJ, Galarneau MR, Potenza BM, Bansal V, Lee JG, Schwartz AK, Dougherty AL, Dye J, Hollingsworth-Fridlund P, Fortlage D, Coimbra R. Combat versus civilian open tibia fractures: the effect of blast mechanism on limb salvage. J Trauma. 2011;70:1241-7. https://doi.org/10.1097/TA.0b013e3182095b52
Russell TA. Fractures of the tibial diaphysis. En: Levine AM. editor. Orthopaedic knowledge update: trauma. Vol 1. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1996. p. 171-9.
Kindsfater K, Jonassen EA. Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma. 1995;9:121-7. https://doi.org/10.1097/00005131-199504000-00006
Sarmiento A. A functional below-the-knee cast for tibial fractures. 1967. J Bone Joint Surg Am. 1967;49:855-74. https://doi.org/10.2106/00004623-196749050-00003
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