Orthopaedic Surgery Department, Vall d'Hebron University Hospital; Universitat Autònoma de Barcelona (Departament de Cirurgia i Cències Morfològiques). Barcelona, Spain; Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain.
Orthopaedic Surgery Department, Vall d'Hebron University Hospital; Universitat Autònoma de Barcelona (Departament de Cirurgia i Cències Morfològiques). Barcelona, Spain; Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain.
Injury. 2022 Oct;53(10):3438-3445. doi: 10.1016/j.injury.2022.08.037. Epub 2022 Aug 18.
Acute tibial fracture-related infection (FRI) is one of the most feared and challenging complications after a tibial fracture. The most appropriate treatment in this scenario is far from a resolved topic. Circular external fixators (CEFs) offer multiplanar control and minimize soft tissue injury using temporary implants far from the infected area. This study aimed to investigate the outcomes of two different types of CEFs (Ilizarov and hexapod) in the treatment of a series of acute tibial FRIs.
A retrospective study at two specialized limb reconstruction centres identified all patients with an acute tibial FRI (≤4 weeks after index procedure) definitively treated with a CEF from January 2015 to December 2020.
fracture healing and infection eradication rate with a minimum FU of 12 months after frame removal.
to investigate the differences between the two types of circular frames regarding final post-treatment deformity magnitude.
We included 31 patients with acute tibial FRIs: 18 treated with hexapod-type and 13 with Ilizarov-type CEFs. Average age was 45.5±16.56 years. Fracture healing and infection eradication were achieved in all patients (31/31) after a mean follow-up of 24.7 months (range 12.1-55.3). Patients treated with an Ilizarov-type fixator presented shorter time to fracture union (5.5±2.2 months vs. 9.2±6.0 months; p-value 0.021) and shorter duration of external fixation (p-value 0.001). Regarding residual post-treatment deformity, the hexapod system presented significantly less residual coronal translation deformity (p-value 0.034) and better callus quality. Fixator-related complications were similar when comparing the two groups. No significant differences were seen in pain (p-value 0.25), RTW rate (35% vs. 45%; p-value 0.7) or functionality (p-value 0.4).
Definitive circular external fixation is an excellent treatment for acute tibial FRI. Both Ilizarov and hexapod systems offer a very high rate of fracture healing and infection eradication. Although both presented very low radiological post-operative residual deformity, the hexapod system showed less residual coronal translation deformity and better callus quality.
急性胫骨骨折相关感染（FRI）是胫骨骨折后最令人恐惧和最具挑战性的并发症之一。在这种情况下，最合适的治疗方法远未得到解决。环形外固定器（CEF）通过使用远离感染区域的临时植入物提供多平面控制并最大程度地减少软组织损伤。本研究旨在探讨两种不同类型的 CEF（伊利扎洛夫和六足）在一系列急性胫骨 FRI 治疗中的效果。
在两个专门的肢体重建中心进行回顾性研究，确定了所有在索引手术后≤4 周内明确接受 CEF 治疗的急性胫骨 FRI 患者。
在去除外固定器后至少 12 个月的 FU 中，骨折愈合和感染清除率。
调查两种类型的环形框架在最终治疗后畸形程度方面的差异。
我们纳入了 31 例急性胫骨 FRI 患者：18 例采用六足型 CEF 治疗，13 例采用伊利扎洛夫型 CEF 治疗。平均年龄为 45.5±16.56 岁。所有患者（31/31）在平均 24.7 个月（12.1-55.3）的随访后均实现了骨折愈合和感染清除。接受伊利扎洛夫型固定器治疗的患者骨折愈合时间更短（5.5±2.2 个月 vs. 9.2±6.0 个月；p 值 0.021），外固定时间更短（p 值 0.001）。关于治疗后残留畸形，六足系统的冠状面平移残余畸形明显较小（p 值 0.034），骨痂质量更好。比较两组时，固定器相关并发症相似。两组之间在疼痛（p 值 0.25）、重返工作岗位率（35% vs. 45%；p 值 0.7）或功能（p 值 0.4）方面没有显著差异。
确定性环形外固定是治疗急性胫骨 FRI 的极好方法。伊利扎洛夫和六足系统均提供非常高的骨折愈合和感染清除率。尽管两种方法术后放射学残留畸形都非常低，但六足系统的冠状面平移残余畸形较小，骨痂质量更好。
