High-energy open tibial fractures in children: Treatment with a programmable circular external fixator
ABSTRACT Between 2005 and 2010 ten consecutive children with high-energy open diaphyseal tibial fractures were treated by early reduction and application of a programmable circular external fixator. They were all male with a mean age of 11.5 years (5.2 to 15.4), and they were followed for a mean of 34.5 months (6 to 77). Full weight-bearing was allowed immediately post-operatively. The mean time from application to removal of the frame was 16 weeks (12 to 21). The mean deformity following removal of the frame was 0.15° (0° to 1.5°) of coronal angulation, 0.2° (0° to 2°) sagittal angulation, 1.1 mm (0 to 10) coronal translation, and 0.5 mm (0 to 2) sagittal translation. All patients achieved consolidated bony union and satisfactory wound healing. There were no cases of delayed or nonunion, compartment syndrome or neurovascular injury. Four patients had a mild superficial pin site infection; all settled with a single course of oral antibiotics. No patient had a deep infection or re-fracture following removal of the frame. The time to union was comparable with, or better than, other published methods of stabilisation for these injuries. The stable fixator configuration not only facilitates management of the accompanying soft-tissue injury but enables anatomical post-injury alignment, which is important in view of the limited remodelling potential of the tibia in children aged > ten years. Where appropriate expertise exists, we recommend this technique for the management of high-energy open tibial fractures in children.
- Injury 09/2012; 43(11):1783-4. DOI:10.1016/j.injury.2012.08.039 · 2.14 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is to present and validate a hinge-fixator technique for the treatment of open tibial fractures, which has advantages in application and the follow up period. The technique was used in open tibia fractures of 14 adult patients. Using this method, initial anatomic reduction was achieved and temporary stability was obtained on the hinge-fixator after applications were completed. Patients' radiological and clinical results were analyzed using the Paley's criteria at the time of the last follow-up. Patients were brought in for followed up analysis over a 5.4 year period. According to Paley, two patients had 'good' and 12 patients had 'excellent' radiological results, while the functional result were excellent (n=13) and good (n=1), respectively. The hinge-fixator technique is a fast and easy method that contributes to shorter operation times, reduced radiation exposure, and more comfortable treatment periods.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 11/2013; 19(6):543-547. DOI:10.5505/tjtes.2013.47936 · 0.38 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In the last twenty years, the incidence of paediatric long bone diaphyseal fractures has increased, owing to changes in the daily-life activities of children. The fracture pattern is different considering the child’s age, the increasing participation in sports and the large number of children involved in car accidents or who are victims of abuse. Healing times will be different depending on age, because younger children take less time to heal. Another characteristic of developmental age is the capacity of spontaneous correction of malalignment. Deformities can be spontaneously corrected in the frontal and sagittal planes, while this is not possible for rotational deformities: this peculiarity of children decreases with age. Therefore, in the choice of therapy the child’s age and the type of fracture should be considered. The type of treatment has changed over the years from a large use of casting treatment to surgical approaches by means of instruments made specifically for the developmental age. The aim of this article is to describe the general characteristics of paediatric diaphyseal fractures of the humerus, forearm, femur and tibia and the principles of non-surgical and surgical treatment in the different age groups. Speaking about non-surgical treatment, the principles of cast application for each anatomical area are described along with the timing of the treatment and the limits of tolerated deformities. The surgical treatment consists of intramedullary osteosynthesis (using elastic nail or Kirschner wires), external fixation and in selected cases plate and screws fixation. The indications for each technique are discussed together with the basics of application and the complications.LO SCALPELLO-OTODI Educational 04/2015; 29(1):36-43. DOI:10.1007/s11639-015-0101-4