exudates and Fractures--Ununited

Infection following grade IIIB open tibial fracture is common. The primary aim of managing this condition is to achieve control of infection before the bone reconstruction procedure is performed. The outcomes for such patients have not been evaluated in the literature. This study was conducted to examine the outcome of a multi-stage procedure for the treatment of infected grade IIIB open tibial fractures.. Between 2004 and 2008, we treated 11 patients with infected grade IIIB open tibial fractures in our unit. The management of infected grade IIIB open tibial fracture comprised three stages, which included serial debridement, wound closure by local flap surgery and bone reconstruction. The margin of resection and the type of bone reconstruction depended on the anatomical location of the disease, the extent of osteomyelitis and patient preference regarding treatment options. Bone reconstruction procedures included bone grafting, plating, interlocking nail, hybrid and monolateral external fixator, and Ilizarov bone transport.. Gram-negative organisms were isolated from all patients. Pseudomonas aeruginosa (P. aeruginosa) (44%) was the most common organism cultured. Infection was resolved in all patients. Nine fractures achieved union, with a mean union time of 15 months. Two patients with P. aeruginosa infection developed non-union of the fracture and refused additional surgery after three years of treatment.. The multi-stage management approach is well-accepted and effective in controlling infection in infected grade IIIB open tibial fractures.

Topics: Adult; Aged; Aged, 80 and over; Debridement; Female; Fracture Fixation; Fractures, Open; Fractures, Ununited; Humans; Ilizarov Technique; Malaysia; Male; Middle Aged; Osteomyelitis; Prospective Studies; Surgical Flaps; Tibial Fractures; Treatment Outcome; Wound Infection

We report the results of external fixation in 29 patients treated for tibial fractures and tibial non-union using a novel multi axial external fixator (MAXX) followed prospectively until bony union. The results of treatment were classified according to the Association for the Study and Application of the Method of Ilizarov (ASAMI). Overall, 13 patients had excellent bone results; 13 had good bone results; two had fair bone results, and 1 patient had poor bone results. Regarding functional results, 21 patients had excellent results; 6 obtained good results; none had fair results, and two had poor results. Acute patients did better functionally than chronic patients. This fixator is safe and versatile, although the indications for its use are very specific.

Topics: Adolescent; Adult; Aged; Bone Transplantation; Developing Countries; Equipment Design; External Fixators; Female; Follow-Up Studies; Fracture Fixation; Fracture Healing; Fractures, Open; Fractures, Ununited; Humans; Malaysia; Male; Middle Aged; Prospective Studies; Reoperation; Tibial Fractures; Treatment Outcome

We are describing 21 limb reconstruction procedures performed in 18 patients with the use of external fixators from 1996 to 1998. The average age of patients was 21, ranging from 1 to 50 years old. Indications for surgery included short limb, non-union, pseudoarthrosis and bone or soft tissue deformities. Average length obtained for cases of limb lengthening was 6 cm. All the seven clubfoot deformities in five children were fully corrected. Equinus deformity recurred in one foot and was treated with supramalleolar osteotomy. Out of the seven cases with infected nonunion and bone loss, three failed to achieve union and required additional bone grafting procedures. One patient with unilateral external fixator for the correction of tibia shortening developed valgus deformity.

Topics: Adolescent; Adult; Bone Lengthening; Child; Child, Preschool; Clubfoot; External Fixators; Extremities; Fractures, Ununited; Hospitals, University; Humans; Infant; Limb Deformities, Congenital; Malaysia; Middle Aged; Radiography