Kamruzzaman M, Mahboob A H, Saha M K, Islam M S, Alam M T, Alamgir M K, Asaduzzaman M
Dr Mohammad Kamruzzaman, Assistant Professor, Department of Orthopedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2020 Apr;29(2):284-289.
Many patients come with open fracture tibia-fibula initially managed by surgical toileting and the application of indigenous uniaxial external fixator in our country. Many of them lead to non-uniting fracture or sometimes signs of union absent within 4 months from the time of initial fracture and become infected also. This quasi experimental study included 40 skeletally matured patients was conducted from 05 February 2014 to 05 February 2018 in the department of Orthopedics, Mymensingh Medical College Hospital, Mymensigh, Bangladesh. The purpose of this study was to evaluate the efficacy of Ilizarov external fixator for treatment of infected gap non-uniting mid shaft tibia-fibula fracture which was initially open fracture Gustilo II to Gustilo III B. Uniaxial external fixators were replaced by to Ilizarov external fixators which multiaxial. Here male 30(75%), female 10(25%) with mean 28 years of age were analyzed in this study based on the inclusion criteria. Twenty eight (70%) fractures had right tibia-fibula while 12(30%) fracture had involved left tibia-fibula. Twelve (30%) patients had a grade II, grade III A- 18(45%), grade IIIB- 10(25%) open fracture tibia-fibula according to the Gustilo and Anderson classification. Initial mode of injury RTA was 28(70%), fall from height 8(20%), physical assault 4(10%). Mean interval between initial trauma and Ilizarov external fixator application was 4.4 months (ranges 4.2-4.8 months).Union or signs of union achieved in all cases in an average time of 17.12 weeks (range 14-20 weeks). The Ilizarov fixator was kept for an average period of 195 days (range 180-210 days). Minimal follow-up was 9 months after complete frame removal (average: 12 months, range: 9-18 months). Based on ASAMI scoring system, bony and functional results were assessed. The bony results were excellent in 24(60%), good in 12(30%), fair in 4(10%) and the Functional results were excellent in 18(45%), good in 16(40%), fair in 4(10%) and poor in 2(5%). In 16(40%) patients 20 wires had pin tract infection in this series. Most pin-tract infections healed well with regular dressing and oral antibiotics but in 8(20%) patients 8 affected loose wires were exchanged. Limb length discrepancy was 1.5cm in 18(45%) patients and 2.0cm in 22(55%) patients. The small sample sizes and short duration of follow-up were the study limitations. We need a life boat or life jacket during journey. As Orthopeadic Surgeon we are always in danger and Ilizarov method is the life boat technology in orthopedic surgery. It restores bone biology without disturbing the medullary cavity. To avoid repeated surgical intervention and to reduce the cost of treatment, we suggest that gap non-uniting infected tibia-fibula fracture which was primarily open should be fixed by Ilizarov external fixator than continuing treatment with indigenous uniaxial external fixator.
在我国，许多胫腓骨开放性骨折患者最初接受手术清创并应用国产单轴外固定器治疗。其中许多患者出现骨折不愈合，有时在初次骨折后4个月内无愈合迹象，还会发生感染。这项准实验研究于2014年2月5日至2018年2月5日在孟加拉国迈门辛市迈门辛医学院医院骨科进行，纳入了40例骨骼成熟的患者。本研究的目的是评估伊利扎洛夫外固定器治疗感染性骨缺损不愈合的胫腓骨中段骨折的疗效，这些骨折最初为开放性骨折，Gustilo II型至Gustilo III B型。将单轴外固定器更换为多轴的伊利扎洛夫外固定器。根据纳入标准，本研究分析了30名男性（75%）和10名女性（25%），平均年龄28岁。28例（70%）骨折发生在右胫腓骨，12例（30%）骨折发生在左胫腓骨。根据Gustilo和Anderson分类，12例（30%）患者为II级开放性胫腓骨骨折，18例（45%）为III A级，10例（25%）为III B级。初始损伤方式为交通事故的有28例（70%），高处坠落的有8例（20%），人身攻击的有4例（10%）。初次创伤与应用伊利扎洛夫外固定器之间的平均间隔时间为4.4个月（范围4.2 - 4.8个月）。所有病例均在平均17.12周（范围14 - 20周）内实现愈合或出现愈合迹象。伊利扎洛夫固定器平均保留195天（范围180 - 210天）。最小随访时间为完全拆除固定架后9个月（平均：12个月，范围：9 - 18个月）。根据ASAMI评分系统评估骨和功能结果。骨结果优秀的有24例（60%），良好的有12例（30%），中等的有4例（10%）；功能结果优秀的有18例（45%），良好的有16例（40%），中等的有4例（10%），差的有2例（5%）。在本系列中，16例（40%）患者有20根钢针发生针道感染。大多数针道感染通过定期换药和口服抗生素愈合良好，但8例（20%）患者更换了8根受影响的松动钢针。18例（45%）患者肢体长度差异为1.5厘米，22例（55%）患者为2.0厘米。样本量小和随访时间短是本研究的局限性。在旅程中我们需要救生艇或救生衣。作为骨科医生，我们始终处于危险之中，而伊利扎洛夫方法是骨科手术中的救生艇技术。它能在不干扰髓腔的情况下恢复骨生物学特性。为避免重复手术干预并降低治疗成本，我们建议对于最初为开放性的感染性骨缺损不愈合的胫腓骨骨折，应采用伊利扎洛夫外固定器固定，而非继续使用国产单轴外固定器治疗。
