MyMedR

Reconstruction of a tibial defect with a previously fractured fibula including the fractured segment as a free osteoseptocutaneous flap

Sadek AF, Halim AS, Ismail FW, Imran YM

Ann Plast Surg, 2014 Oct;73(4):402-4.

PMID: 23851368 DOI: 10.1097/SAP.0b013e31827fb387

Reconstruction of major bone defects using free fibular transfer provides a good biological option in unsound situations. Most authors recommend selection of the recipient blood vessels outside the zone of injury to achieve successful free fibular transfer. Occasionally, in polytraumatized patients, the surgeon has to use a previously fractured fibula as a graft, with increased risk of inclusion of the injury zone that may lead to failure.

Matched MeSH terms: Fractures, Open/surgery*

Fulltext Severe open fracture of the tibia associated with massive soft tissue loss: limb salvage revisited

Shamsuddin AA, Mujait K

Med J Malaysia, 2005 Jul;60 Suppl C:108-10.

PMID: 16381294

The choice between limb salvage and primary amputation in a severely injured limb is at time difficult. A case of severe Gustilo type-IIIB open fracture of the tibia with massive soft tissue loss is presented to highlight the immediate and definitive treatment undertaken to preserve the limb.

Matched MeSH terms: Fractures, Open/surgery*

Fulltext Clinical experience with reamed locked nails for close and open comminuted tibial diaphyseal fractures: a review of 50 consecutive cases

Zainudin M, Razak M, Shukur SH

Med J Malaysia, 2000 Sep;55 Suppl C:59-67.

PMID: 11200046

We present the results of our experience in treating comminuted tibial shaft fractures with reamed interlocking intramedullary nail from September 1993 to December 1995. In this retrospective study, there were fifty patients with an average follow-up of 14.3 months (range six to twenty-eight months). Ninety-eight percent of the fractures were due to motor-vehicle accident with majority of the patients being motorcyclist (96%). Thirty-eight fractures were closed and twelve were open (Gustilo grade I--8; grade II--4); 44% of them had additional fractures or other injuries. According to Winquist-Hansen classification of diaphyseal fracture comminution, there were 24% type I; 18% type II; 26% type III and 32% type IV. The union rate was 98%. There were 6 infections, 2 superficial and 4 deep. All these infections arose from closed fractures, which was possibly due to the long operative time. No patients with open fractures, which underwent delayed nailing, had infection. One of the patient had severe deep infection which required early nail removal before union. Anterior knee pain following nailing occurred in 6% of the patients. The average hospital stay after operation was 3.4 days. Ninety-four percent of the patients had excellent to good functional outcome after nailing. The mean time to regain full range of movement of knee and ankle was 8.4 weeks. Patients were allowed full weight bearing in the average time of 10.7 weeks and the mean time to return to work was 24.7 weeks.

Matched MeSH terms: Fractures, Open/surgery*

The treatment of open tibial fractures and of tibial non-union with a novel external fixator

Ong CT, Choon DS, Cabrera NP, Maffulli N

Injury, 2002 Nov;33(9):829-34.

PMID: 12379395

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.

Matched MeSH terms: Fractures, Open/surgery*

Fulltext Recalcitrant post-traumatic chronic osteomyelitis/infected non-union of the tibia following open grade-ill fractures: treatment with vascularized osteocutaneous fibular graft

Halim AS, Imran Y

Med J Malaysia, 2006 Feb;61 Suppl A:66-70.

PMID: 17042234

Post-traumatic chronic osteomyelitis and infected non-unions of the tibia following severe type-III open fracture are difficult to treat Refractoy cases often necessitate amputation despite attempts to salvage the limb. We report our experience in treating such difficult cases with an alternative surgical option using free osteocutaneous fibular graft. Eight consecutive patients with post-traumatic chronic osteomyelitis/infected non-union were treated surgically with free vascularized osteocutaneous fibular graft. Outcomes in term of graft-host union and complication were evaluated. Four patients had anastomotic venous thrombosis requiring anastomotic revision. Five patients developed surgical site infections needing extended antibiotic therapy to achieve resolution at an average of 15.2 weeks. Fibular graft fracture occurred in three patients but all grafts survived and united after a mean time to union of 42.3 weeks (range 31 to 82 weeks). At the final follow-up, union of host-graft junction and control of infection were achieved in all patients except one who required a secondary amputation. Free vascularized osteo-cutaneous fibular graft is a viable limb salvage option for refractory chronic osteomyelitis or infected non-union following treatment of grade-III open tibial fractures.

Matched MeSH terms: Fractures, Open/surgery

Percutaneous intramedullary supracondylar nailing for fractures of distal femur

Patel K, Kapoor A, Daveshwar R, Golwala P

Med J Malaysia, 2004 May;59 Suppl B:206-7.

PMID: 15468890

A prospective study of 25 patients with supracondylar and intercondylar fracture of the femur was carried out from January 1999 to June 2003 at SSG Hospital, Baroda, India. Twenty-eight percent fractures were open and 72% were closed. Twelve pecent of the fractures had intraarticular extension. AO classification was used to classify the fractures. Eighty-four percent of the fractures were due to high velocity trauma. All the cases were operated by percutaneous supracondylar nailing. No postoperative complication related to fracture treatment was seen. Average follow up was 20.1 months (range 6-40 months). Average age of the patients was 31.5 years. Average time of union was 3.1 months (range 2-4 months). Average knee range of motion was 117 degrees. Even in open injuries, 85.7% had more than 110 infinity range of motion. All patients could return to their pre-injury lifestyle. Rating scale developed by Hospital for Special Surgery was used to quantify the results. Eighty-four percent showed excellent, 8% showed good and 8% showed fair results. Percutaneous supracondylar nailing is thus, an excellent method of treating fractures of distal femur.

Matched MeSH terms: Fractures, Open/surgery*

Surgical Reconstruction of an Open Medial Malleolus Fracture Using a Novel Technique: A Case Report

Kow RY, Yuen JC, Ahmad Alwi AA, Abas MF, Low CL

JBJS Case Connect, 2019 6 25;9(2):e0163.

PMID: 31233428 DOI: 10.2106/JBJS.CC.18.00163

CASE: A 17-year-old male sustained an open fracture of the right medial malleolus (MM) with significant bone and soft tissue loss following a motor-vehicle accident. Following serial wound debridement, his ankle was effectively reconstructed with MM antiglide plate stabilization, iliac autogenous bone graft, and a free radial forearm soft tissue flap.

CONCLUSIONS: Open MM fracture with bone and soft tissue loss is rare. It is feasible to treat this injury with a novel surgical reconstruction technique involving autogenous bicortical iliac bone graft and radial forearm free flap.

Matched MeSH terms: Fractures, Open/surgery*

The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

Mohamed Haflah NH, Ng MH, Mohd Yunus MH, Naicker AS, Htwe O, Fahmi M, et al.

Int J Low Extrem Wounds, 2017 Sep;16(3):212-216.

PMID: 28862056 DOI: 10.1177/1534734617724974

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

Matched MeSH terms: Fractures, Open/surgery*

Fulltext Outcomes of infected grade IIIB open tibial fractures

Yusof NM, Halim AS

Singapore Med J, 2012 Sep;53(9):591-4.

PMID: 23023900

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.

Matched MeSH terms: Fractures, Open/surgery*

Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report

Halim AS, Yusof I

J Orthop Surg (Hong Kong), 2004 Jun;12(1):110-3.

PMID: 15237132

Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.

Matched MeSH terms: Fractures, Open/surgery*

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