Henry Joshua A, Ali Almigdad, Elkhidir Ibrahim H, Reid Adam, Wong Jason, Pillai Anand
Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, GBR.
Department of Medicine, University of Khartoum, Khartoum, SDN.
Cureus. 2023 May 16;15(5):e39103. doi: 10.7759/cureus.39103. eCollection 2023 May.
Background Open fractures associated with significant tissue loss are complex and present challenges in management; they are associated with poor outcomes such as infection, non-union or amputation. This study aimed to evaluate outcomes of using an adjuvant local antibiotic hydroxyapatite bio-composite in the management of open Gustilo-Anderson IIIB fractures with up to eight years of follow-up. Methods This was a retrospective study. A total of 81 patients with Gustilo-Anderson IIIB fractures treated with "fix and flap" limb reconstruction with adjuvant local antibiotic therapy using a bio-composite carrier were reviewed. Results The mean follow-up time for all the patients, at the time of data collection, was 55.8 months. Union was achieved in 96% with a limb salvage rate of 96.3% and a deep infection rate of 3.7%. Conclusion The use of local antibiotic therapy, together with a combined orthoplastic "fix and flap" approach for Gustilo-Anderson IIIB open fractures, was found to be associated with a very low rate of metalwork infection and high union and limb salvage rates. Future studies should include some functional and quality of life outcome measures to see the efficacy of this method.
伴有严重组织缺损的开放性骨折较为复杂，在治疗方面存在挑战；它们与感染、骨不连或截肢等不良预后相关。本研究旨在评估使用辅助性局部抗生素羟基磷灰石生物复合材料治疗开放性 Gustilo-Anderson IIIB 骨折并进行长达八年随访的疗效。方法：这是一项回顾性研究。共纳入 81 例接受“固定加皮瓣”肢体重建并使用生物复合材料载体进行辅助性局部抗生素治疗的 Gustilo-Anderson IIIB 骨折患者。结果：在数据收集时，所有患者的平均随访时间为 55.8 个月。骨折愈合率为 96%，肢体挽救率为 96.3%，深部感染率为 3.7%。结论：对于 Gustilo-Anderson IIIB 开放性骨折，采用局部抗生素治疗并结合整形修复的“固定加皮瓣”方法，发现金属植入物感染率极低，骨折愈合率和肢体挽救率高。未来研究应纳入一些功能和生活质量结局指标，以观察该方法的疗效。
