Destructive injury is defined as a very serious damage both to the bone and the soft tissues. But in clinical practice we found that in some fracture cases, the damage to soft tissues is not as severe as "destructive injury" indicates, whereas comminuted fractures still cannot show the severity of bone damage. Therefore we proposed a new term "destructive fractures" after combining the definition of destructive injury with typical clinic cases. Destructive fractures refer to the fractures whose osseous tissues are damaged too seriously to be repaired, but soft tissues, nerves and veins are less severely injured and can be repaired. From the year 2001 to 2010, 75 cases of destructive fractures were admitted in our department. According to whether the fractures interlinked with the external environment, together with the fracture sites, they were divided into 6 types: a1 type, closed diaphysis destructive fracture; a2 type, open diaphysis destructive fracture; b1 type, closed joint-involved destructive fracture; b2 type, open joint-involved destructive fracture; c1 type, closed mixed destructive fracture; c2 type, open mixed destructive fracture. Corresponding clinical treatments were conducted for each type.The new classification criterion of destructive fracture is simple and practical and thus can be used as an important guide to make reasonable treatment plans for destructive fractures.
Fracture Fixation, Internal ; Fractures, Closed ; Fractures, Comminuted ; surgery ; Fractures, Open ; surgery ; Humans

Segmental bone defects are very severe in open fractures of the lower extremity. Traditional treatment requires skeletal stabilization, usually by external fixation, followed by free tissue transfer for soft tissue coverage, and vascularized or nonvascularized bone grafting for the skeletal defect. The bone transport distraction osteogenesis is a new method for treating bone defects. The range of bone loss for which bone transport is indicated 3 to 12 cm. The method required only small bone grafts to stimulate healing at the bone defect site, whereas patients in the conventionally treated group needed a larger volume of cancellous bone graft. Donor site morbidity was less in the method, and no free-tissue transfers were required. Disadvantages of the method was a complex, time-consuming reconstruction. In the appropriately selected patient, when the surgeon is experienced in the technique, treatment by bone transport distraction osteogenesis offers unique advantages for certain cases of the bone defect.
Bone Transplantation ; Fractures, Open ; surgery ; Humans ; Osteogenesis, Distraction ; methods

OBJECTIVETo assess the outcome of immediate plate osteosynthesis via application of antibiotic impregnated collagen fleeces (gentamicin-collagen and antibiotic sponge) which gradually release antibiotic locally in the surgical treatment of open fractures presented to us 6 hours after injury.

METHODSAll cases were treated in our tertiary level trauma center and teaching hospital including 35 patients with open fractures who were treated by immediate open reduction and plate fixation from January 2008 to August 2010. Among them, 31 patients were available for adequate follow-up and assessment. All fractures were treated by irrigation and debridement, immediate open reduction and plate fixation along with placement of antibiotic-releasing collagen fleeces around the plate just before closure of wound. Patients were assessed to determine postoperative infection, delayed union or nonunion and development of other postoperative complications. It was hypothesized that immediate plate osteosynthesis after thorough debridement and local antibiotics would give safe and acceptable clinical results in treatment of open fractures.

RESULTSThe 31 patients with adequate final follow-up were assessed at a mean time of 40 weeks (15-160 weeks). Most fractures united primarily in an acceptable time period according to area of involvement. Local wound complications (superficial infection and skin loss) were found in 3 patients (9.67%). Deep infection was noted in 2 patients (6.45%). None of these patients needed implant removal and both fractures united in due time. Delayed union was noted in 5 patients (16.13%). No patient progressed to nonunion or implant failure in long term follow-up. Excessive scarring was developed in 2 patients (6.45%).

CONCLUSIONSImmediate plate osteosynthesis after adequate debridement and placement of collagen film eluting antibiotics locally produces excellent results regarding bone union and absence of deep infections and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

Animals ; Collagen ; Fracture Fixation, Internal ; Fractures, Open ; surgery ; Gentamicins ; Humans ; Porifera ; Tibial Fractures ; surgery

OBJECTIVETo explore the effects of early external fixation for open tibia and fibula fractures on the treatment and prognosis of severe multiple injuries.

METHODSSeventy-three patients were reviewed in the study. According to the surgical methods for tibia and fibula fractures, the patients with severe multiple injuries were divided into 2 groups: 42 patients in the treatment group, including 31 males and 11 females, with an average age of 40.2 years; 31 patients in the control group, ineluding 22 males and 9 females, with an average age of 42.6 years. The patients in treatment group were treated urgently with debridement, diaplasis and fixation with external fixator, and patients in control group were treated urgently with debridement, calcaneal traction or gypsum external fixation. The incidence rate and mortality of ARDS and MODS, wound infection rate, wound healing time, and fracture healing time between the 2 groups was compared.

RESULTSThe incidence rate and mortality of complications (ARDS) had significant differences between the 2 groups, those in the treatment group were lower than those in the control group (P < 0.05). There were significant decreases in the infection rate and wound healing time in the treatment group.

CONCLUSIONExternal fixation for severe multiple injuries with open tibia and fibula fracture has been proved to be good, which can significantly reduce the mortality and incidence rate of complications and wound infection rate, promote wound healing.

Adult ; External Fixators ; Female ; Fibula ; injuries ; surgery ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Multiple Trauma ; surgery ; Tibial Fractures ; surgery

OBJECTIVETo discuss the clinical effect of closed reduction and interlocking intramedullary nailing in the treatment of femoral shaft fracture.

METHODSFrom March 2006 to December 2011,103 patients with femoral shaft fracture were treated by closed reduction and interlocking intramedullary nailing including 76 males and 27 females with an average age of 36 years old ranging from 19 to 55 years old. According to AO classification,there were 64 cases with type A,27 with type B, 12 with type C. Thirteen cases were open fractures including 5 cases with Gustilo type I , 8 with Gustilo type II . The time of bone healing were observed after operation, the knee function recovery was evaluated by HSS scoring standard at 1 year after operation.

RESULTSThe intraoperative complications included femoral neck fracture in 1 case and proximal femoral fracture in 1 case,both of the patients were treated with reconstructive intramedullary interlocking nail and the fractures healed postoperatively. One patient was suffered from common peroneal nerve injury,which were fully recovered at 4 months later after medical treatment. All the patients were followed up from 12 to 28 months (averaged 22 months). All of the fractures were healed well and the average healing time was 3 to 9 months (averaged 5 months). All the hip joints were recovered to normal function. The average HSS was 90.89±5.06 at 1 year after operation.

CONCLUSIONInterlocking intramedullary nailing is the preferred treatment for patients with femoral shaft fracture. Carefully operating and closed reduction can reduce the complications.

Adult ; Bone Nails ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate therapeutic effects of external fixator combined with artificial skin for the treatment of lower limb open fractures.

METHODSFrom January 2009 to February 2011,56 patients with lower limb open fractures were treated with external fixator and artificial skin following debridement. There were 42 males and 14 females, with a mean age of 43.6 years (ranged, 18 to 68 years). Wound surface or cavities were filled with artificial skin with embedded drainage tubes connected to vacuum bottle. The wounds were closed with secondary suturing, or free flap, or flap transfer at 5-7 days after primary operation. The therapeutic effects were evaluated by observing the wound healing, wound bacterial culture, healing time, recovery of limb function.

RESULTSThe wounds of 56 patients all healed. Fifty-three patients had bone primary union, and 3 patients had delayed union. The average union time was 5.8 months. There was pin-tract infection in 3 cases and superficial infection in 1 case. According to Ovadia evaluation criteria,45 patients got an excellent results, 9 good and 2 fair.

CONCLUSIONArtificial skin combined with external fixator is a simple and effective treatment method for Gustilo III type severe open fractures of legs, which is effective to provide rapid fixation, seal wounds, and shorten secondary healing time of wounds.

Adolescent ; Adult ; Aged ; External Fixators ; Female ; Fibula ; injuries ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Skin, Artificial ; Tibial Fractures ; surgery

This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracture-dislocations of the left hip (Pipkin's type IV) and knee (Moore II) joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin's fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no instability in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.
Adult ; Fractures, Open ; surgery ; Hip Dislocation ; surgery ; Humans ; Knee Dislocation ; surgery ; Leg Injuries ; surgery ; Male ; Tomography, X-Ray Computed

OBJECTIVETo investigate the type and corresponding operation methods of ulnar lateral mass in distal radial fractures.

METHODSFrom January 2004 to September 2010,32 cases of distal radial fractures with ulnar lateral mass were treated by surgical incision and relocate ulnar lateral mass,including 23 males and 9 females with an average age of (34 +/- 9) years old ranging from 28 to 65 years old. According to the classification of Melone-Doi, 2 cases with type I, 24 cases of type II, 6 cases with type III. The operative appoach involved palm-radial, palm-ulnar, radial-dorsal. Among them, 28 patients with closed fractures were fixed with plate, 4 cases (including 2 cases of open fractures) were fixed by Kirschner pin and braces.

RESULTSThirty-two patients were followed up for 8 to 18 months with an average of 12 months. All fractures were healing without complications. According to modified Gartland-Werley scoring system (GWSS), the total score was 1.12 +/- 0.45, the remain deformity was 0, subjective evaluation was 0.50 +/- 0.30, objective evaluation was 0.30 +/- 0.21, complications was 0.40 +/- 0.09; the result was excellent in 21 cases, good in 11 cases.

CONCLUSIONThe location of ulnar lateral mass in distal radial fractures is one of the important prognostic factors in wrist function and surgical treatment is an effective method of fixing ulnar lateral mass in distal radial fractures.

Adult ; Aged ; Bone Nails ; Bone Plates ; External Fixators ; Female ; Fracture Fixation ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Treatment Outcome ; Ulna Fractures ; surgery

OBJECTIVETo explore the therapeutic effectiveness of Ilizarov technique in treatment of infected tibial defects combined with overlaying skin defects.

METHODSTwenty-one cases with infected tibial defects combined with skin defects were treated between 2001 and 2008 includeing 18 males and 3 females with an average age of 31 years ranging from 19 to 43 years. The length of bone defect ranged from 3 to 13 cm (means 6 cm). Skin defect area was from 3 cm x 3 cm to 6 cm x 10 cm; 11 cases combined with drop foot, 5 cases with arthrocleisis of knee. Preoperative X-ray of the affected limb was performed and zone of skin necrosis was marked, then the point and length of osteotomized bone, and scope of bone and soft tissue need for removing were determined. The internal fixation were removed. Opening irrigation, vacuum sealing drainage (VSD), and dressing changing were appllied. The skin was fixed with Kirschner wire and bone was transferred with Ilizarov technique in all patients. The lengthening of bone and skin was carried out for 4 to 7 days after surgery, 1/6 to 1/4 mm once, 4 to 6 times a day. The clinical effectiveness was determined mainly through wound and lengthening of skin.

RESULTSAll patients were followed up for from 6 to 62 months (means 49.5 months). Fourteen of 21 cases received one stage treatment, there was still secretion from end of bone in 3 patients whose bone healed after debridement, the other 4 patients were cured via trimming end of bone and compression fusion. The defects of bone were extended to full length in 18 patients. Abutting end was slightly absorbed and became rattailed in 2 cases, there was lack of blood supply to abutting ends in one patient who was cured via bone graft from iliac bone. Skin defects was cured in 18 patients with one stage treatment, the other 3 patients were cured after infection was controlled. The deformity of drop foot were corrected in 11 patients, and function of knee was improved in five patients. The external fixator was removed at 1.2 to 2.6 years after surgery. At last, bone infections were cured, defects of bone and skin recovered in all patients.

CONCLUSIONOne stage treatment of infected tibial defects combined with skin defects using Ilizarov technique has minimal invasion with less complex surgeries, could reduce the time and expense of treatment.

Adult ; Female ; Fractures, Open ; surgery ; Humans ; Ilizarov Technique ; Male ; Necrosis ; Postoperative Complications ; surgery ; Skin ; pathology ; Soft Tissue Injuries ; surgery ; Tibia ; surgery ; Tibial Fractures ; pathology ; surgery

Adolescent ; Child ; External Fixators ; utilization ; Female ; Fibula ; injuries ; Fractures, Open ; surgery ; Humans ; Male ; Tibia ; injuries