Hidayat Luthfi, Triangga Aditya Fuad Robby, Cein Caesarean Rayhan, Irfantian Ardicho, Rahayu Bernadeta Fuad Paramita, Resubun Alan Philips, Magetsari Rahadyan
Orthopaedics and Traumatology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia; Orthopaedics and Traumatology Department, Universitas Gadjah Mada Academic Hospital, Yogyakarta, Indonesia.
Orthopaedics and Traumatology Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Int J Surg Case Rep. 2022 Apr;93:106882. doi: 10.1016/j.ijscr.2022.106882. Epub 2022 Feb 26.
External fixators are the most common fixation method for fractures with substantial soft tissue compromise. Nonetheless, the frames used are bulky, uncomfortable, and cumbersome to patients. Using locking compression plate (LCP) as an external fixator (low profile external fixation/LPEF) owns the same properties as standard external fixators but may overcome disadvantages because of its low-profile frame. This case series aims to evaluate the results of LPEF for the management of tibia fracture with soft tissue compromise.
We reviewed five patients at our centers who underwent surgery in 2020 with the application of LPEF. These patients had grade IIIA open tibia fracture with respective complications. The follow-up duration was 6 months post-operative in which we assessed Southampton Wound Assessment Scale (SWAS), laboratory infection markers, radiographic evaluation, and the Lower Extremity Functional Scale (LEFS). The results showed all wounds healed and cases with infection showed tendency of resolving, alongside varying degree of bone healing. The implant was well tolerated for patients and the functional outcome was overall good (mean LEFS: 71.26%).
The LPEF is fortuitously lightweight and more convenient for patients to ambulate, thus the compliance of early functional exercise is more likely to happen.
Application of LPEF can be considered as an option for treating soft tissue compromised tibia fracture. In our experience, it is low profile, more acceptable to the patients, and displayed favorable outcomes especially in terms of soft tissue or skin healing and infection resolution.
外固定器是治疗伴有严重软组织损伤骨折最常用的固定方法。然而，所使用的外固定架体积庞大，患者佩戴不舒适且行动不便。使用锁定加压钢板（LCP）作为外固定器（低轮廓外固定/LPEF）具有与标准外固定器相同的特性，但因其低轮廓框架可能克服其缺点。本病例系列旨在评估LPEF治疗伴有软组织损伤的胫骨骨折的效果。
我们回顾了2020年在我们中心接受LPEF手术的5例患者。这些患者均为ⅢA型开放性胫骨骨折并伴有相应并发症。术后随访6个月，期间我们评估了南安普顿伤口评估量表（SWAS）、实验室感染指标、影像学评估以及下肢功能量表（LEFS）。结果显示所有伤口均愈合，感染病例有好转趋势，同时伴有不同程度的骨愈合。患者对植入物耐受性良好，功能结果总体良好（平均LEFS：71.26%）。
LPEF意外地重量轻，更便于患者行走，因此更有可能实现早期功能锻炼的依从性。
LPEF的应用可被视为治疗伴有软组织损伤的胫骨骨折的一种选择。根据我们的经验，它外形低轮廓，患者更易接受，并且显示出良好的效果，尤其是在软组织或皮肤愈合以及感染消退方面。
