Akbari Aghdam Hossein, Sheikhbahaei Erfan, Hajihashemi Hamidreza, Kazemi Davoud, Andalib Ali
Orthopaedic Surgery Department, School of Medicine, Kashani University Hospital, Isfahan University of Medical Sciences, Mid Kashani St. Felezi Br., Isfahan, Iran.
Students Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Eur J Orthop Surg Traumatol. 2019 Jan;29(1):183-187. doi: 10.1007/s00590-018-2275-y. Epub 2018 Jul 2.
High-energy tibial fractures may cause compartment syndrome, which needs fasciotomy. However, in this procedure, close fractures become an open wound and choosing the best type of fixation for this situation has been a problem. We assumed early open reduction and internal fixation (ORIF) instead of late internal fixation or external fixation, or stage-based approach is a better method.
We collected fifty-seven medical records from 2012 to 2017 stored in Alzahra and Kashani University Hospital databases. We selected important information of their medical files, called the submitted phone numbers, and asked them to come to our clinic and examined their leg for any malunion and/or movement restriction postoperatively. We asked about pain and paresthesia in their leg. Twelve cases were excluded.
Demographic variables were not significantly different between these two groups. Deep infection, malunion, decreased range of motion in both knee and ankle joints, pain and paresthesia mainly occurred in external fixation group, except malunion (p value = 0.032), other variables were not statistically significant between two groups. More surgeries were performed predominantly for external fixation group (p value < 0.001). External fixation stayed 4.7 days longer at hospital although it was not statistically significant (p value = 0.108).
It is better to perform fasciotomy and ORIF simultaneously in one surgery to lower the number of surgeries, days of hospitalization, decrease the risk of deep infection, malunion and movement restriction although its postoperative outcomes were not considerably different from external fixation. We indicate that stage-based approach is accompanied by poor outcomes and lesser satisfaction.
高能胫骨骨折可能导致骨筋膜室综合征，需要进行筋膜切开术。然而，在此手术过程中，闭合性骨折会变成开放性伤口，为这种情况选择最佳的固定类型一直是个问题。我们认为早期切开复位内固定（ORIF）而非晚期内固定或外固定，或者分阶段治疗方法是更好的选择。
我们收集了2012年至2017年存储在阿尔扎赫拉和卡沙尼大学医院数据库中的57份病历。我们选取了他们医疗档案中的重要信息，即提交的电话号码，并要求他们前来我们的诊所，检查其腿部术后是否有畸形愈合和/或活动受限情况。我们询问了他们腿部的疼痛和感觉异常情况。排除了12例。
两组之间的人口统计学变量无显著差异。深部感染、畸形愈合、膝关节和踝关节活动范围减小、疼痛和感觉异常主要发生在外固定组，除畸形愈合外（p值 = 0.032），两组之间其他变量无统计学意义。外固定组进行的手术更多（p值 < 0.001）。外固定组在医院的停留时间长4.7天，尽管无统计学意义（p值 = 0.108）。
最好在一次手术中同时进行筋膜切开术和切开复位内固定，以减少手术次数和住院天数，降低深部感染、畸形愈合和活动受限的风险，尽管其术后结果与外固定相比没有显著差异。我们指出分阶段治疗方法的结果较差且满意度较低。
