External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study
•Treatment options for open fracture of the tibial shaft fixation include external fixation with or without early conversion to internal fixation.•External fixation with early conversion to internal fixation demonstrated satisfying results regarding union rate, time to union, wound infection.•Superf...
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| Veröffentlicht in: | Injury 2024-06, Vol.55, p.111477, Article 111477 |
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| creator | Le Baron, Marie Maman, Pascal Volpi, Richard Flecher, Xavier |
| description | •Treatment options for open fracture of the tibial shaft fixation include external fixation with or without early conversion to internal fixation.•External fixation with early conversion to internal fixation demonstrated satisfying results regarding union rate, time to union, wound infection.•Superficial infection and numerous surgeries were found as deep infection risk factors.•Time for wound closure >7 days, time for reoperation >28 days, numerous surgeries and deep infection were found as consolidation failure factors.•Early conversion of external to internal fixation is an effective option to achieve bone union of open tibial fracture for selected patients.
Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.
The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.
Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).
In the “IF” group, the union rate was 69.7 % at 6.3 +/-3.6 months (3–16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only (“EF” group) showed a union rate of 51.3 % at 8.9 +/-4 (5–22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.
Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients. |
| doi_str_mv | 10.1016/j.injury.2024.111477 |
| format | Article |
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Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.
The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.
Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).
In the “IF” group, the union rate was 69.7 % at 6.3 +/-3.6 months (3–16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only (“EF” group) showed a union rate of 51.3 % at 8.9 +/-4 (5–22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.
Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.</description><identifier>ISSN: 0020-1383</identifier><identifier>ISSN: 1879-0267</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2024.111477</identifier><identifier>PMID: 39069345</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adult ; Aged ; External fixation ; External Fixators ; Female ; Fracture Fixation - methods ; Fracture Fixation, Internal - methods ; Fracture Healing ; Fractures, Open - surgery ; Humans ; Infection ; Male ; Middle Aged ; Reoperation - statistics & numerical data ; Risk Factors ; Secondary fixation ; Skin closure ; Surgical Wound Infection ; Tibial Fractures - surgery ; Time Factors ; Treatment Outcome ; Union ; Young Adult</subject><ispartof>Injury, 2024-06, Vol.55, p.111477, Article 111477</ispartof><rights>2024</rights><rights>Copyright © 2024. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c241t-15f8fb389a3917b3ca301a3a48ccb05fe919ba21895834d543b01ca959d898173</cites><orcidid>0000-0002-8833-7454 ; 0000-0002-2229-3620</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2024.111477$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39069345$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Le Baron, Marie</creatorcontrib><creatorcontrib>Maman, Pascal</creatorcontrib><creatorcontrib>Volpi, Richard</creatorcontrib><creatorcontrib>Flecher, Xavier</creatorcontrib><title>External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study</title><title>Injury</title><addtitle>Injury</addtitle><description>•Treatment options for open fracture of the tibial shaft fixation include external fixation with or without early conversion to internal fixation.•External fixation with early conversion to internal fixation demonstrated satisfying results regarding union rate, time to union, wound infection.•Superficial infection and numerous surgeries were found as deep infection risk factors.•Time for wound closure >7 days, time for reoperation >28 days, numerous surgeries and deep infection were found as consolidation failure factors.•Early conversion of external to internal fixation is an effective option to achieve bone union of open tibial fracture for selected patients.
Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.
The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.
Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).
In the “IF” group, the union rate was 69.7 % at 6.3 +/-3.6 months (3–16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only (“EF” group) showed a union rate of 51.3 % at 8.9 +/-4 (5–22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.
Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.</description><subject>Adult</subject><subject>Aged</subject><subject>External fixation</subject><subject>External Fixators</subject><subject>Female</subject><subject>Fracture Fixation - methods</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fracture Healing</subject><subject>Fractures, Open - surgery</subject><subject>Humans</subject><subject>Infection</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Reoperation - statistics & numerical data</subject><subject>Risk Factors</subject><subject>Secondary fixation</subject><subject>Skin closure</subject><subject>Surgical Wound Infection</subject><subject>Tibial Fractures - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Union</subject><subject>Young Adult</subject><issn>0020-1383</issn><issn>1879-0267</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctq3TAQhkVpSU6TvEEpWnbj0xnLFymLQgjpBQLZNGshyyOig491Kslp_B594Dp12iwKWc1ivvl_ho-xdwhbBGw-7rZ-3E1x3pZQVltErNr2FdugbFUBZdO-ZhuAEgoUUhyztyntALAFIY7YsVDQKFHVG_br6iFTHM3AnX8w2YeRm8R7cn702d8Tz5FM3tOYeYic_oNdGIbwk3rezZxMHObnlR95ONCCRGPzFCnx4Hi-WyJ955eMdGdcPucXS1uy0R_-1KU89fMpe-PMkOjsaZ6w289X3y-_Ftc3X75dXlwXtqwwF1g76TohlREK205YIwCNMJW0toPakULVmRKlqqWo-roSHaA1qla9VBJbccI-rLmHGH5MlLLe-2RpGMxIYUpagKwb2WAJC1qtqI0hpUhOH6LfmzhrBP3oQ-_06kM_-tCrj-Xs_VPD1O2p_3f0V8ACfFoBWv689xR1sp5GS72PZLPug3-54Td_yqDQ</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Le Baron, Marie</creator><creator>Maman, Pascal</creator><creator>Volpi, Richard</creator><creator>Flecher, Xavier</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8833-7454</orcidid><orcidid>https://orcid.org/0000-0002-2229-3620</orcidid></search><sort><creationdate>202406</creationdate><title>External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study</title><author>Le Baron, Marie ; Maman, Pascal ; Volpi, Richard ; Flecher, Xavier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c241t-15f8fb389a3917b3ca301a3a48ccb05fe919ba21895834d543b01ca959d898173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>External fixation</topic><topic>External Fixators</topic><topic>Female</topic><topic>Fracture Fixation - methods</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fracture Healing</topic><topic>Fractures, Open - surgery</topic><topic>Humans</topic><topic>Infection</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Reoperation - statistics & numerical data</topic><topic>Risk Factors</topic><topic>Secondary fixation</topic><topic>Skin closure</topic><topic>Surgical Wound Infection</topic><topic>Tibial Fractures - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Union</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Le Baron, Marie</creatorcontrib><creatorcontrib>Maman, Pascal</creatorcontrib><creatorcontrib>Volpi, Richard</creatorcontrib><creatorcontrib>Flecher, Xavier</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Le Baron, Marie</au><au>Maman, Pascal</au><au>Volpi, Richard</au><au>Flecher, Xavier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2024-06</date><risdate>2024</risdate><volume>55</volume><spage>111477</spage><pages>111477-</pages><artnum>111477</artnum><issn>0020-1383</issn><issn>1879-0267</issn><eissn>1879-0267</eissn><abstract>•Treatment options for open fracture of the tibial shaft fixation include external fixation with or without early conversion to internal fixation.•External fixation with early conversion to internal fixation demonstrated satisfying results regarding union rate, time to union, wound infection.•Superficial infection and numerous surgeries were found as deep infection risk factors.•Time for wound closure >7 days, time for reoperation >28 days, numerous surgeries and deep infection were found as consolidation failure factors.•Early conversion of external to internal fixation is an effective option to achieve bone union of open tibial fracture for selected patients.
Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.
The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.
Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).
In the “IF” group, the union rate was 69.7 % at 6.3 +/-3.6 months (3–16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only (“EF” group) showed a union rate of 51.3 % at 8.9 +/-4 (5–22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.
Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>39069345</pmid><doi>10.1016/j.injury.2024.111477</doi><orcidid>https://orcid.org/0000-0002-8833-7454</orcidid><orcidid>https://orcid.org/0000-0002-2229-3620</orcidid></addata></record> |
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| subjects | Adult Aged External fixation External Fixators Female Fracture Fixation - methods Fracture Fixation, Internal - methods Fracture Healing Fractures, Open - surgery Humans Infection Male Middle Aged Reoperation - statistics & numerical data Risk Factors Secondary fixation Skin closure Surgical Wound Infection Tibial Fractures - surgery Time Factors Treatment Outcome Union Young Adult |
| title | External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study |
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