Marwan Yousef, Turner Jeffrey, Senan Rahul, Muir Ross, Barron Elizabeth, Hadland Yvonne, Moulder Elizabeth, Sharma Hemant
Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait.
Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):353-361. doi: 10.1007/s00590-023-03660-5. Epub 2023 Aug 2.
The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures.
Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included.
20 patients with a mean age of 47.8 ± 16.5 years (range: 15-69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1 days (range = 49-364), while the mean follow-up duration following frame removal was 3.2 ± 1.8 years (range = 2-8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2 cm (2; 10.0%).
Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.
胫骨骨折内固定失败的处理仍是骨科医生面临的一项挑战。本研究探讨环形外固定在胫骨骨折内固定失败处理中的效用及结果。
2022年12月，对一家大型创伤中心复杂肢体重建单元前瞻性收集的数据库进行回顾性分析。纳入接受环形外固定架翻修手术的胫骨骨折内固定失败患者。
纳入20例患者，平均年龄47.8±16.5岁（范围：15 - 69岁）。14例（70.0%）患者钢板螺钉固定失败，其余6例（30.0%）髓内钉固定失败。翻修手术最常见的指征是术后早期手术部位感染（5例；25.0%）。外固定架治疗的平均时长为199.5±80.1天（范围 = 49 - 364天），而拆除外固定架后的平均随访时长为3.2±1.8年（范围 = 2 - 8年）。本系列患者的总体愈合率为100%；所有感染病例的感染均完全消退。并发症总数为11例，然而，仅2例并发症需要手术干预。报告的最常见并发症是针道感染（6例；30.0%）和肢体长度相差2 cm（2例；10.0%）。
环形外固定是治疗胫骨骨折内固定失败的可靠手术选择。该技术可在复杂的感染和非感染病例中挽救肢体，愈合率高且主要并发症极少。
