The Management of Soft Tissue and Bone Loss in Type IIIB and IIIC Pediatric Open Tibia Fractures

被引:19
作者
Laine, Jennifer C. [1 ]
Cherkashin, Alexander [2 ]
Samchukov, Mikhail [2 ]
Birch, John G. [2 ]
Rathjen, Karl E. [2 ]
机构
[1] Gillette Childrens Specialty Healthcare, 200 Univ Ave East, St Paul, MN 55101 USA
[2] Texas Scottish Rite Hosp Children, Dallas, TX 75219 USA
关键词
EXTERNAL FIXATION; COMPRESSION-DISTRACTION; SPATIAL FRAME; CHILDREN; DEFECTS; FLAP; RECONSTRUCTION; EXTREMITIES;
D O I
10.1097/BPO.0000000000000492
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose: Type III B and C open tibia fractures in children pose a challenge to the orthopaedic surgeon. Limb salvage is the initial goal for the majority of patients, but managing soft-tissue defects and bone loss can be a challenge. The purpose of this study was to evaluate the use of circular external fixation in the management of these injuries. Methods: In this retrospective review, we examined children with type IIIB and IIIC open tibial fractures treated with circular external fixation and soft-tissue coverage between 1990 and 2010. Chart review included: mechanism and severity of injury, degree of bone and soft-tissue loss, technique and duration of external fixation, additional procedures, clinical and radiographic outcomes, and complications. Results: Eight patients were identified whose average age at the time of injury was 10.4 years (range, 3.8 to 15.3 y). There were 7 type IIIB and 1 type IIIC fractures. All patients received free or rotational soft-tissue flaps. Average bone loss was 5.4 cm (range, 0 to 12 cm). Three techniques of circular external fixation were used, including: (1) static stabilization to allow for soft-tissue coverage and fracture healing, (2) acute shortening with plan for later limb lengthening, and (3) stabilization of the extremity for soft-tissue coverage and intended bone transport. Seven of 8 limbs were salvaged. Of those 7, all were followed to skeletal maturity and ambulating without assistive devices at final follow- up. Three patients had a clinically relevant leg-length discrepancy (>= 2 cm). Four of 8 patients required secondary or contralateral procedures. Conclusions: Pediatric type IIIB and IIIC tibia fractures are limb-threatening injuries that require dynamic thinking and management as the bone and soft-tissue injuries evolve. We have proposed a general algorithm to guide the treatment of these severe injuries. In our experience, circular external fixation, in conjunction with this algorithm, provides the appropriate stability and environment for managing soft tissue and bone loss and can facilitate limb salvage.
引用
收藏
页码:453 / 458
页数:6
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