External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study.
Humans
Tibial Fractures
/ surgery
Fractures, Open
/ surgery
Male
Female
External Fixators
Adult
Middle Aged
Treatment Outcome
Fracture Fixation
/ methods
Fracture Fixation, Internal
/ methods
Fracture Healing
Reoperation
/ statistics & numerical data
Aged
Time Factors
Risk Factors
Surgical Wound Infection
Young Adult
External fixation
Infection
Secondary fixation
Skin closure
Union
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Jun 2024
Jun 2024
Historique:
received:
23
11
2023
revised:
08
02
2024
accepted:
25
02
2024
medline:
29
7
2024
pubmed:
29
7
2024
entrez:
28
7
2024
Statut:
ppublish
Résumé
Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation. The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications. Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group). In the "IF" group, the union rate was 69.7 % at 6.3 +/-3.6 months (3-16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only ("EF" group) showed a union rate of 51.3 % at 8.9 +/-4 (5-22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors. Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.
Identifiants
pubmed: 39069345
pii: S0020-1383(24)00164-5
doi: 10.1016/j.injury.2024.111477
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
111477Informations de copyright
Copyright © 2024. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of competing interest Marie Le Baron: no conflict of interest, Pascal Maman: consultant for Newclip, Richard Volpi: no conflict of interest, Xavier Flecher: consultant for Zimmer and Stryker endoscopy