Single-Stage Conversion of External Fixation into Internal Fixation for Compound Fractures in War-Wounded Patients: A Cohort Study in Iraq
DOI:
https://doi.org/10.54133/ajms.v7i2.1357Keywords:
External Fixators, Fracture Fixation, Compound Fractures, Gunshot WoundsAbstract
Background: War-induced. Compound fractures cause considerable damage to the limbs, affecting mobility and quality of life; surgeons consider managing compound fractures to be a difficulty. Although multi-stage conversion from external to internal fixation is still common, multiple studies worldwide are promoting single-stage conversion. Objective: To assess the efficacy and safety of a single-stage conversion from external to internal fixation using the functional results of many Iraqi war wounded patients who were initially treated with external fixation. Methods: A retrospective cohort study analyzed the data of 40 war-wounded patients (39 males and 1 female) ranging in age from 18 to 50 years. All patients came with war-related complex fractures, which were stabilized and referred for external fixation. Following a single-stage conversion to internal fixation, the patients were followed up to assess the functional outcomes of this approach using Ketenjian's functional criteria. Results: A study of 40 patients (45 limbs), mostly male (97.8%), demonstrated a statistically significant link between non-union and time to convert from external to internal fixation. However, fracture type, Gustilo categorization, fixation method, and complication rates had no significant impact on Ketenjian's score results. Conclusions: The single-staged external to internal fixation conversion is regarded as a safe and reliable procedure with good overall functional outcomes; it could be performed by experienced surgeons instead of two-staged conversions, taking into account the patient's general health and the state of the local soft tissue.
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Li J, Wang Q, Lu Y, Feng Q, He X, Li Md Z, et al. Relationship Between Time to Surgical Debridement and the Incidence of Infection in Patients with Open Tibial Fractures. Orthop Surg. 2020;12:524-532. 20200322. doi: 10.1111/os.12653.
Al-Shahawani Z. Early and definitive treatment of war compound fracture. Iraqi J Commun Med. 2012;25:352-356.
Ren GH, Xiang DY, Wu XH, Chen YB, Li R. A neglected problem in the utilization of free anterolateral thigh flap toward reconstructing complicated wounds of extremities: the obliteration of deep dead space. J Orthop Surg Res. 2020;15:483. 20201021. doi: 10.1186/s13018-020-01914-0.
Li R, Zhu G, Chen C, Chen Y, Ren G. Bone transport for treatment of traumatic composite tibial bone and soft tissue defects: Any specific needs besides the Ilizarov technique? Biomed Res Int. 2020;2020:2716547. doi: 10.1155/2020/2716547.
Matsumura T, Takahashi T, Miyamoto O, Saito T, Kimura A, Takeshita K. Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb. J Orthop Sci. 2019;24:888-893. doi: 10.1016/j.jos.2019.01.009.
Ye Z, Zhao S, Zeng C, Luo Z, Yuan S, Li R. Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities. J Orthop Surg Res. 2021;16:662. doi: 10.1186/s13018-021-02814-7.
Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38:1261-1267. doi: 10.1007/s00264-014-2294-1.
Reuss BL, Cole JD. Effect of delayed treatment on open tibial shaft fractures. Am J Orthop. (Belle Mead NJ) 2007;36:215-220.
Fang X, Jiang L, Wang Y, Zhao L. Treatment of Gustilo grade III tibial fractures with unreamed intramedullary nailing versus external fixator: a meta-analysis. Med Sci Monit. 2012;18:Ra49-56. doi: 10.12659/msm.882610.
Roussignol X, Sigonney G, Potage D, Etienne M, Duparc F, Dujardin F. Secondary nailing after external fixation for tibial shaft fracture: risk factors for union and infection. A 55 case series. Orthop Traumatol Surg Res. 2015;101:89-92. doi: 10.1016/j.otsr.2014.10.017.
Nambi GI, Salunke AA, Thirumalaisamy SG, Babu VL, Baskaran K, Janarthanan T, et al. Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap. Chin J Traumatol. 2017;20:99-102. doi: 10.1016/j.cjtee.2016.06.011.
O'Brien PJ, Meek RN, Powell JN, Blachut PA. Primary intramedullary nailing of open femoral shaft fractures. J Trauma. 1991;31:113-116. doi: 10.1097/00005373-199101000-00022.
Della Rocca GJ, Crist BD. External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft. J Am Acad Orthop Surg. 2006;14:S131-5. doi: 10.5435/00124635-200600001-00030.
Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999;13:85-91. doi: 10.1097/00005131-199902000-00003.
Ketenjian AY and Shelton ML. Primary internal fixation of open fractures: a retrospective study of the use of metallic internal fixation in fresh open fractures. J Trauma. 1972;12:756-763.
Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, et al. Fracture-related infection: A consensus on definition from an international expert group. Injury. 2018;49:505-510. doi: 10.1016/j.injury.2017.08.040.
Hosny G, Fadel M. Ilizarov external fixator for open fractures of the tibial shaft. Int Orthop. 2003;27:303-306. doi: 10.1007/s00264-003-0476-3.
Antich-Adrover P, Martí-Garin D, Murias-Alvarez J, Puente-Alonso C. External fixation and secondary intramedullary nailing of open tibial fractures. A randomised, prospective trial. J Bone Joint Surg Br. 1997;79:433-437.
Boriani F, Ul Haq A, Baldini T, Urso R, Granchi D, Baldini N, et al. Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study. J Plast Reconstr Aesthet Surg. 2017;70:715-722. doi: 10.1016/j.bjps.2017.02.017.
McGraw JM, Lim EV. Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. J Bone Joint Surg Am. 1988;70:900-911.
Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation. J Bone Joint Surg Br. 1986;68:246-254. doi: 10.1302/0301-620x.68b2.3514629.
Velazco A, Fleming LL. Open fractures of the tibia treated by the Hoffmann external fixator. Clin Orthop Relat Res. 1983:125-132.
Vincent HK, Horodyski M, Vincent KR, Brisbane ST, Sadasivan KK. Psychological distress after orthopedic trauma: Prevalence in patients and implications for rehabilitation. PM R. 2015;7(9):978-989. doi: 10.1016/j.pmrj.2015.03.007.
Claydon JH, Robinson L, Aldridge SE. Patients' perceptions of repair, rehabilitation and recovery after major orthopaedic trauma: a qualitative study. Physiotherapy. 2017;103:322-329. doi: 10.1016/j.physio.2015.11.002.
Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34:583-588. doi: 10.1007/s00264-009-0832-z.
Parekh AA, Smith WR, Silva S, Agudelo JF, Williams AE, Hak D, et al. Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. J Trauma. 2008;64:736-739. doi: 10.1097/TA.0b013e31804d492b.
Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am. 2000;82:781-788.
Omura T, Omichi Y, Kosaka H. Open pelvic fracture with bilateral common iliac arteriovenous injury successfully treated with hemicorporectomy following damage control interventional radiology in a hybrid emergency room. Acute Med Surg. 2020;7:e575. doi: 10.1002/ams2.575.
Blachut PA, O'Brien PJ, Meek RN, Broekhuyse HM. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997;79:640-646. doi: 10.2106/00004623-199705000-00002.
Broos PL, Miserez MJ, Rommens PM. The monofixator in the primary stabilization of femoral shaft fractures in multiply-injured patients. Injury. 1992;23:525-528. doi: 10.1016/0020-1383(92)90151-h.
Sirkin M, Sanders R, DiPasquale T, Herscovici D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004;18:S32-38. doi: 10.1097/00005131-200409001-00005.
Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15:153-160. doi: 10.1097/00005131-200103000-00002.
Giannoudis PV. Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br. 2003;85:478-483. doi: 10.1302/0301-620x.85b4.14217.
Clasper JC, Cannon LB, Stapley SA, Taylor VM, Watkins PE. Fluid accumulation and the rapid spread of bacteria in the pathogenesis of external fixator pin track infection. Injury. 2001;32:377-381. doi: 10.1016/s0020-1383(01)00008-0.
Clasper JC, Parker SJ, Simpson AH, Watkins PE. Contamination of the medullary canal following pin-tract infection. J Orthop Res. 1999;17:947-952. doi: 10.1002/jor.1100170621.
Chua W, Murphy D, Siow W, Kagda F, Thambiah J. Epidemiological analysis of outcomes in 323 open tibial diaphyseal fractures: a nine-year experience. Singapore Med J. 2012;53:385-389.
Malhotra AK, Goldberg S, Graham J, Malhotra NR, Willis MC, Mounasamy V, et al. Open extremity fractures: impact of delay in operative debridement and irrigation. J Trauma Acute Care Surg. 2014;76:1201-1207. doi: 10.1097/ta.0000000000000205.
Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77:417-421.
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