Korovessis P, Milis Z, Christodoulou G, Spastris P, Sdougos G, Katsoudas G, Voutsinas A
Department of Orthopedic Surgery, General Hospital Agios Andreas, Patras, Greece.
J Trauma. 1992 Jan;32(1):77-81.
A change in the method of managing open-grade-III tibial shaft fractures provided a new opportunity for a comparative study. One series of patients was treated exclusively by internal fixation and compared with another series treated with external fixation solely as well as with a series treated initially by external skeletal fixation and later by "Sarmiento walking plaster." The latter method was found to be a successful treatment and a good alternative to internal fixation for open grade-II and grade-III tibial shaft fractures when soft-tissue healing was completed. The supplementary use of the Sarmiento walking plaster had dramatically decreased the duration of hospital stay, saving the patient from an additional operation. There were no nonunions in this series. In open grade-I-II tibial shaft fractures, the deep infection rate in the cases in which internal fixation was used was significantly higher (5.4%), than that observed in the cases treated with external fixation, in which there was no deep infection. The nonunion rate was higher (22%) in the external fixation group compared with the internal fixation group (9%). The functional impairment of the ankle joint of the affected limb was less (15%) by using internal fixation than that of either the external fixation group (20%) or the group where the external fixation was changed to a Sarmiento walking plaster (35%).
开放性Ⅲ级胫骨干骨折治疗方法的改变为一项对比研究提供了新机会。一组患者仅接受内固定治疗，并与另一组仅接受外固定治疗的患者以及一组最初接受外骨骼固定、随后接受“萨米恩托行走石膏”治疗的患者进行比较。结果发现，后一种方法是一种成功的治疗方法，对于开放性Ⅱ级和Ⅲ级胫骨干骨折，在软组织愈合完成后，是内固定的良好替代方法。补充使用萨米恩托行走石膏显著缩短了住院时间，使患者无需进行额外手术。该组无骨不连病例。在开放性Ⅰ - Ⅱ级胫骨干骨折中，使用内固定的病例深部感染率显著更高（5.4%），高于接受外固定治疗的病例，后者无深部感染。外固定组的骨不连率（22%）高于内固定组（9%）。使用内固定时，患侧踝关节的功能障碍（15%）低于外固定组（20%）或由外固定改为萨米恩托行走石膏治疗的组（35%）。
