Shekouhi Ramin, Ahmed Syeda Hoorulain, Chim Harvey
Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
J Hand Microsurg. 2025 May 23;17(4):100287. doi: 10.1016/j.jham.2025.100287. eCollection 2025 Jul.
The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in conjunction with open reduction and internal fixation (ORIF) and hardware placement. Secondary objectives were to determine incidence of fracture union and limb salvage. Finally, we sought to identify flap-related factors that might impact rates of infection, flap failure, and nonunion.
A consecutive single-surgeon series was studied. Baseline patient characteristics, flap-related factors, incidence of hardware failure, amputation, and non-union were extracted and analyzed.
A total of 37 consecutive patients with a mean age of 38.9 ± 16.4 years were included, with a mean postoperative follow-up of 703.4 ± 459.6 days. There were 9 patients (24.3 %) with hardware failure and deep tissue infection. Time from injury to flap and time from last ORIF to flap were not significantly different between patients with hardware failure and those without. Flap type (muscle versus fasciocutaneous), smoking status, diabetes and body mass index were not associated with hardware failure. Multivariate regression analysis controlling for potential confounders showed that older age in patients was the only significant factor predicting hardware failure. Bone union was achieved in 29 (78.4 %) patients. Mean time from surgery to radiological signs of union was 329.3 ± 425.3 days.
In patients requiring free flap reconstruction and ORIF for open tibial and ankle fractures, age was the only significant non-modifiable risk factor for hardware failure.
本研究的主要目的是调查一组开放性胫骨和踝关节骨折患者在接受游离皮瓣覆盖联合切开复位内固定（ORIF）及置入内固定物后内固定物失败的发生率及相关因素。次要目的是确定骨折愈合和肢体挽救的发生率。最后，我们试图找出可能影响感染率、皮瓣失败率和骨不连的皮瓣相关因素。
对一个由单一外科医生连续治疗的系列病例进行研究。提取并分析患者的基线特征、皮瓣相关因素、内固定物失败、截肢和骨不连的发生率。
共纳入37例连续患者，平均年龄38.9±16.4岁，术后平均随访703.4±459.6天。有9例患者（24.3%）发生内固定物失败并伴有深部组织感染。内固定物失败患者与未失败患者从受伤到皮瓣移植的时间以及从最后一次切开复位内固定到皮瓣移植的时间无显著差异。皮瓣类型（肌皮瓣与筋膜皮瓣）、吸烟状况、糖尿病和体重指数与内固定物失败无关。控制潜在混杂因素的多变量回归分析显示，患者年龄较大是预测内固定物失败的唯一显著因素。29例（78.4%）患者实现了骨愈合。从手术到出现影像学愈合征象的平均时间为329.3±425.3天。
对于需要游离皮瓣重建和切开复位内固定治疗开放性胫骨和踝关节骨折的患者，年龄是内固定物失败唯一显著的不可改变的危险因素。
