Department of Trauma & Orthopaedics, Sheffield Teaching Hospitals, South Yorkshire, United Kingdom.
J Orthop Trauma. 2024 Aug 1;38(8):447-451. doi: 10.1097/BOT.0000000000002841.
The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo-Anderson 3B open tibial fractures.
A prospectively maintained database was retrospectively interrogated.
Single major trauma center in the United Kingdom.
All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors.
The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions.
Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases.
Orthoplastic care including circular frame fixation for Gustilo-Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%).
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在报告一家大型创伤中心在治疗 Gustilo-Anderson 3B 型开放性胫骨骨折患者时使用环形框架进行确定性固定的经验。
对一个前瞻性维护的数据库进行回顾性查询。
英国的一家主要创伤中心。
所有年龄在 16 岁以上的患者，在研究中心进行初始清创术，患有开放性胫骨骨折。所有患者还接受矫形治疗以治疗软组织缺损（通过骨骼变形或软组织覆盖术），随后使用 Ilizarov 环形固定器进行确定性治疗。未在其他中心接受初次清创术、有既往感染、发生关节周围骨折或无法进行至少 12 个月随访的患者被排除在外。查阅病历和 X 线片以收集患者的人口统计学和损伤因素。
主要结局为深部感染率，次要结局包括愈合时间和二次干预。
225 例患者符合纳入标准。平均年龄为 43.2 岁，男性占 72%，吸烟者占 34%，糖尿病患者占 3%。环形框架管理的总持续时间平均为 6.4 个月（SD 7.7）。8 例（3.5%）患者发生深部感染，41 例（20%）出现针道感染迹象。79 例（35.1%）患者进行了二次干预，其中 8 例为深部感染清创术，29 例为骨手术，8 例为软组织手术，30 例为框架调整，4 例患者需要软组织和骨手术的联合治疗。221 例（98.2%）患者实现了骨性愈合，195 例（86.7%）在无需二次干预的情况下单框架愈合，26 例需要调整框架以实现愈合。10 例患者使用了自体骨移植物。
包括环形框架固定在内的矫形治疗治疗 Gustilo-Anderson-3B 型胫骨骨折，深部感染率低（3.5%），愈合率高（98.2%）。
预后 III 级。请参阅作者说明，以获取完整的证据水平描述。
