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外部损伤控制固定对确定性骨固定的干扰

INTERFERENCE OF EXTERNAL DAMAGE CONTROL FIXATION IN DEFINITIVE OSTEOSYNTHESIS.

作者信息

Mussatto Julio Cesar DO Amaral, Balsimelli Fernando, Mussatto Guilherme DO Amaral, Zamboni Caio, Christian Ralph Walter, Mercadante Marcelo Tomanik

机构信息

Santa Casa de Misericórdia de São Paulo, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

出版信息

Acta Ortop Bras. 2022 Aug 26;30(4):e250322. doi: 10.1590/1413-785220223004e250322. eCollection 2022.

Abstract

INTRODUCTION

Indications for provisional external fixation prior to the definitive treatment of fractures are associated with the control of local and systemic damage and the impossibility of definitive osteosynthesis in the emergency.

OBJECTIVE

To identify complications associated with external fixation prior to definitive internal osteosynthesis.

METHODS

This is a comparative, prospective study (Level II). Inclusion criteria: patients treated as emergencies (November 2019 and March 2020) who underwent provisional external correction followed by definitive osteosynthesis. We look for signs of inadequacies in external correction and correlation with infections (erythema, hyperemia, fistulae in the path of the pins or surgical scars), systemic symptoms of infection, and radiographic parameters for treatment up to eight weeks after surgery.

RESULTS

The average time for conversion to definitive osteosynthesis was 15.9 days and 47 lower limbs and three upper limbs were fixed. Of the participants who had deep infections, three (6%) showed signs during initial treatment (external fixator) and nine (18%), after definitive internal osteosynthesis. We found no correlation between provisional external correction and complications in the definitive treatment with osteosynthesis.

CONCLUSION

The use of temporary external fixation before definitive internal osteosynthesis in fractures of the appendicular skeleton failed to increase complication rates even if the path of the implants in both procedures overlapped.

摘要

引言

在骨折的确定性治疗之前进行临时外固定的指征与局部和全身损伤的控制以及在急诊情况下无法进行确定性骨合成有关。

目的

确定在确定性内固定之前进行外固定相关的并发症。

方法

这是一项比较性前瞻性研究(二级)。纳入标准:2019年11月至2020年3月作为急诊治疗的患者,先进行临时外固定矫正,随后进行确定性骨合成。我们寻找外固定矫正不足的迹象以及与感染(红斑、充血、针道或手术瘢痕处的瘘管)、感染的全身症状以及术后长达八周的治疗影像学参数之间的相关性。

结果

转换为确定性骨合成的平均时间为15.9天,共固定了47条下肢和3条上肢。在深部感染的参与者中,3例(6%)在初始治疗(外固定器)期间出现症状,9例(18%)在确定性内固定术后出现症状。我们发现在骨合成的确定性治疗中,临时外固定与并发症之间没有相关性。

结论

在四肢骨骼骨折的确定性内固定之前使用临时外固定,即使两种手术中植入物的路径重叠,也不会增加并发症发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/527a/9425999/6c3b12b628fb/1809-4406-aob-30-04-e250322-gf1.jpg

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