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ABSTRACT: The aim of this study was to review high-energy subtrochanteric fractures treated biologically with the 95° angled blade plate, to assess the time to union and return to work, and to perform a functional evaluation using the traumatic hip rating scale.
This study is a retrospective review of 22 patients with 23 fractures. Twenty-one patients (96 %) with 22 fractures were available for analysis. The average age was 33 years (range 18-47). There were seventeen males and four females. The right side was involved in fifteen patients, the left in five patients, and one patient had bilateral fractures. Motor vehicle accident was the predominant mode of injury in eleven patients. Seven patients had other associated injuries. 32B2.1 (40 %) was the commonest fracture pattern according to the OTA classification.
The average follow-up period was 29 months (range 12-49). The mean time to fracture healing was 16 weeks (range 12-32). All patients returned to their pre-fracture occupation (100 %). Eighteen patients (86 %) healed without any additional surgery. The outcome according to the hip rating scale was excellent in ten patients and good in eleven patients. Two patients (9 %) required additional surgery.
Biological fixation of subtrochanteric fractures using 95° CBP results in a high union rate with low morbidity and good functional outcome.
Journal of Orthopaedic Science 06/2012; 17(5):567-73. · 0.84 Impact Factor
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ABSTRACT: Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover. We reviewed the results of the local flaps of lower limb, done by orthopedic surgeons.
We retrospectively reviewed the results of the lower limb flaps done between January 2005 and December 2006. All flaps done at and below the level of knee were included.
There were 105 patients with 120 flaps during this period. Two patients with two flaps were lost to follow-up. The average age was 32 years. Sixty-four patients had Type IIIB Gustilo and Anderson injuries. Thirty-nine patients had isolated soft tissue injuries. The indications for flaps were exposed bone, tendon, and joint in 45, 11, and 12, respectively, or a combination in 35 patients. The flaps done were 51 reverse sural artery, 35 gastrocnemius, 25 local fasciocutaneous, and seven foot flaps. The flap dimensions ranged from 2 × 2 to 30 × 15 cm. Ninety-three flaps (79%) healed primarily. Among 25 flaps (21%) with necrosis, 14 flaps required secondary split skin graft for healing, while the other nine flaps healed without further surgery.
Appropriate soft tissue cover provided by orthopedic surgeons can help in providing independent, composite care of lower limb injuries.
Journal of Emergencies Trauma and Shock 07/2011; 4(3):325-9.
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ABSTRACT: The ring fixator is an ideal apparatus to treat infected gap nonunion of the tibia and to correct deformity in multiple planes. However soft tissue problems may arise during transport and at docking. Although various options such as free flaps, neurocutaneous flaps, fasciocutaneous flaps and cross leg flaps are available for flap cover, this is always done prior to application of a ring fixator. The versatility of the sural flap in terms of coverage of leg defects, ease of performing flap cover as well as its reliability and safety is well known. We describe an alternate way of treating soft tissue problems which occur at the lower third of the leg while being treated on an Ilizarov frame. We describe the surgical procedure followed in raising the flap and its anterior transposition within the Ilizarov frame in two patients.
Acta orthopaedica Belgica 10/2010; 76(5):684-8. · 0.40 Impact Factor
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ABSTRACT: The gastrocnemius muscle flap has been used extensively for cover around the knee. However, the use of the lateral gastrocnemius for cover of the distal thigh has not been well described.
The lateral gastrocnemius flap was used in eight patients from October 2004 to February 2009 for cover of the distal thigh proximal to the knee joint. We included patients who had soft tissue loss secondary to trauma and infection and who required soft tissue cover in the distal lateral thigh (>8 cm proximal to the joint line). The average age of the patients was 40 years (21-64 years). Four patients had soft tissue loss secondary to trauma, two had loss secondary to chronic infection, and two patients had soft tissue loss after surgical infection.
All patients had resolution of infection at final follow-up. The average area of soft tissue cover achieved was 14 × 9 cm. The maximal proximal extent reached with lateral gastrocnemius flap from the joint line was 17 cm (8-17 cm) measured in full knee extension. There were two complications. One patient developed a common peroneal palsy and infection, which recovered after re-exploration. Another patient developed a sinus, which resolved after removal of a loose screw.
The lateral gastrocnemius muscle flap is effective in the cover of the lateral distal thigh.
The Journal of trauma 03/2010; 69(5):E38-41. · 2.48 Impact Factor
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ABSTRACT: We present a patient with an open, infected Achilles tendon injury with a soft tissue defect of 12 cm x 5 cm and a tendon defect of 10 cm. He underwent a two-stage procedure. A first stage debridement of tendon and soft tissue was followed by a second stage tendo Achilles reconstruction using fascia lata graft and soft tissue cover with a reverse flow sural flap. He had a good functional outcome with minimal donor site morbidity.
Foot and Ankle Surgery 02/2008; 14(2):96-9.
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Injury 07/2006; 37(6):573. · 1.98 Impact Factor
