Michael Wagels1, Dan Rowe2, Shireen Senewiratne2, Tavis Read2, David R Theile2. 1. Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia. Electronic address: michaelwagels@hotmail.com. 2. Princess Alexandra Hospital, Brisbane, Australia.
Abstract
BACKGROUND: Outcomes in management of compound tibial fractures are measured by the rate of infection and non-union. These are a function of many variables that interact in complex ways. Our aims are to describe changes in these injuries over the past decade, to determine which variables predict a poor outcome and to compare reconstructive options controlling for these variables. METHODS: All compound tibial fractures reconstructed at the Princess Alexandra Hospital from 1999 to early 2009 were reviewed retrospectively. The remainder of 2009 and 2010 were reviewed prospectively. Data were collected from departmental audits, medical records and imaging. RESULTS: 251 flaps were performed in 235 patients. Reconstructions within one week declined after 2000, which correlated with increasing Negative Pressure Dressings use (R = 0.77). Free flap use increased though the incidence of distal fractures did not (R = 0.29). Muscle flaps were consistently preferred. Injuries with a poor outcome had a greater delay or failed soft tissue reconstruction. A poor outcome was more likely in patients with a contaminated distal fracture (p = 0.0038). Outcomes in muscle and fasciocutaneous flaps were not significantly different. CONCLUSIONS: Compound tibial fracture management has evolved to temporary followed by definitive fixation. Free flap use has increased, particularly in diaphyseal injuries. Delays in reconstruction should prompt aggressive surgical management. Injuries at risk of a poor outcome can be further characterised as being distal and contaminated. Reconstructive surgeons should not be discouraged from using muscle flaps. A management algorithm based on the evidence provided is presented. LEVEL OF EVIDENCE: Therapeutic III. Crown
BACKGROUND: Outcomes in management of compound tibial fractures are measured by the rate of infection and non-union. These are a function of many variables that interact in complex ways. Our aims are to describe changes in these injuries over the past decade, to determine which variables predict a poor outcome and to compare reconstructive options controlling for these variables. METHODS: All compound tibial fractures reconstructed at the Princess Alexandra Hospital from 1999 to early 2009 were reviewed retrospectively. The remainder of 2009 and 2010 were reviewed prospectively. Data were collected from departmental audits, medical records and imaging. RESULTS: 251 flaps were performed in 235 patients. Reconstructions within one week declined after 2000, which correlated with increasing Negative Pressure Dressings use (R = 0.77). Free flap use increased though the incidence of distal fractures did not (R = 0.29). Muscle flaps were consistently preferred. Injuries with a poor outcome had a greater delay or failed soft tissue reconstruction. A poor outcome was more likely in patients with a contaminated distal fracture (p = 0.0038). Outcomes in muscle and fasciocutaneous flaps were not significantly different. CONCLUSIONS: Compound tibial fracture management has evolved to temporary followed by definitive fixation. Free flap use has increased, particularly in diaphyseal injuries. Delays in reconstruction should prompt aggressive surgical management. Injuries at risk of a poor outcome can be further characterised as being distal and contaminated. Reconstructive surgeons should not be discouraged from using muscle flaps. A management algorithm based on the evidence provided is presented. LEVEL OF EVIDENCE: Therapeutic III. Crown
Authors: David S Sparks; Siamak Saifzadeh; Flavia Medeiros Savi; Constantin E Dlaska; Arne Berner; Jan Henkel; Johannes C Reichert; Martin Wullschleger; Jiongyu Ren; Amaia Cipitria; Jacqui A McGovern; Roland Steck; Michael Wagels; Maria Ann Woodruff; Michael A Schuetz; Dietmar W Hutmacher Journal: Nat Protoc Date: 2020-02-14 Impact factor: 13.491
Authors: Raquel Bernardelli Iamaguchi; Lucas Sousa Macedo; Alvaro Baik Cho; Marcelo Rosa de Rezende; Rames Mattar; Teng Hsiang Wei Journal: Rev Bras Ortop (Sao Paulo) Date: 2022-03-11