Jingxin Pan1, Ying Gao2, Jing Li3, Junjun Fan3, Tao Yang4, Zhenbang Yang5, Jiang Shuang5, Zhuojing Luo6, Zhijun Pan7, Zhi Yuan3. 1. Air Force Military Medical University, Xi'an, 710032, Shaanxi, China. ylpanzhijun@163.com. 2. Yanan University, Yan'an, China. 3. Air Force Military Medical University, Xi'an, 710032, Shaanxi, China. 4. Yulin Fourth Hospital of Shanxi Province, Yulin, China. 5. Yulin First Hospital of Shanxi Province, Yulin, China. 6. Department of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China. 7. Yulin Fourth Hospital of Shanxi Province, Yulin, China. ylpanzhijun@163.com.
Abstract
OBJECTIVE: Infection and nonunion are the two most challenging issues for high-energy fractures. This study aimed to explore the clinical effect of benign inflammation-cultivated bone growth activity in the treatment of closed/small-sized open and high-energy fractures. METHODS: This study is a case series of closed/small-sized open and high-energy fractures of the lower limbs treated at our hospital from April 2009 to February 2017. All patients underwent debridement and external fixation in the early stage, followed by internal fixation in the second stage. After the operation, fracture healing was monitored by X-ray, and early-stage knee function training was initiated. Also, bone grafting was performed to stimulate the healing reaction, eliminating the atrophic nonunion factors. RESULTS: The operation in all 75 cases was carried out after the inflammatory responses completely subsided, leading to secondary wound healing. Bony union appeared in 71 patients who did not suffer from any pain and could stand up and walk without any restriction. Among them, 68 patients could flex their knee > 100°, and three patients had knee flexion ranging from 80 to 100°. No infections occurred after the second operation. CONCLUSION: This two-stage treatment for high-energy fractures could avoid the damage caused by excessive inflammatory responses that occurred following early-stage one-time internal fixation. This method protected benign inflammatory-callus reactions induced by the primary injury and utilized the advantages of closed reduction in AO fixation with open reduction, thereby avoiding potential infection and nonunion caused by one-time fixation during the early stage.
OBJECTIVE: Infection and nonunion are the two most challenging issues for high-energy fractures. This study aimed to explore the clinical effect of benign inflammation-cultivated bone growth activity in the treatment of closed/small-sized open and high-energy fractures. METHODS: This study is a case series of closed/small-sized open and high-energy fractures of the lower limbs treated at our hospital from April 2009 to February 2017. All patients underwent debridement and external fixation in the early stage, followed by internal fixation in the second stage. After the operation, fracture healing was monitored by X-ray, and early-stage knee function training was initiated. Also, bone grafting was performed to stimulate the healing reaction, eliminating the atrophic nonunion factors. RESULTS: The operation in all 75 cases was carried out after the inflammatory responses completely subsided, leading to secondary wound healing. Bony union appeared in 71 patients who did not suffer from any pain and could stand up and walk without any restriction. Among them, 68 patients could flex their knee > 100°, and three patients had knee flexion ranging from 80 to 100°. No infections occurred after the second operation. CONCLUSION: This two-stage treatment for high-energy fractures could avoid the damage caused by excessive inflammatory responses that occurred following early-stage one-time internal fixation. This method protected benign inflammatory-callus reactions induced by the primary injury and utilized the advantages of closed reduction in AO fixation with open reduction, thereby avoiding potential infection and nonunion caused by one-time fixation during the early stage.
Authors: Peter V Giannoudis; David Hak; David Sanders; Erin Donohoe; Theodoros Tosounidis; Chelsea Bahney Journal: J Orthop Trauma Date: 2015-12 Impact factor: 2.512
Authors: Markus Rupp; Christoph Biehl; Matthäus Budak; Ulrich Thormann; Christian Heiss; Volker Alt Journal: Int Orthop Date: 2017-12-22 Impact factor: 3.075
Authors: Joseph Westgeest; Donald Weber; Sukhdeep K Dulai; Joseph W Bergman; Richard Buckley; Lauren A Beaupre Journal: J Orthop Trauma Date: 2016-03 Impact factor: 2.512