Objectives Historically, in the pre-antiseptic era, there was a great fear of open tibial factors because of high incidence of infection eventually leading to amputation and in many cases septicemia and death. Despite improvements in surgical techniques in the last century, the optimum treatment for open type IIIa and Type II tibial farcture remains controversial. Literature available on use of Ex-fix as a definitive and permanent modality is very sparse and is not encouraging. In order to maintain biology of the fracture and to expedite the healing process many institutions and surgeons are using Locking compression plate as an external fixator which is fondly called as supracutaneous plating (SCP). Material and Methods The patients who had Gustilo and Anderson type II and IIIa # of distal Tibia were enrolled in this study. They were randomized into 2 groups. In one group (Ex-Fix) external fixator was applied in and in another group SCP was done. Four general indicators, including direct cost of hospitalization, first surgery time, time to full weight bearing, and time to complete union were compared between the groups. The functional outcome of the ankle was assessed. Presence of infection, Time to union was noted in both cases. Results Mean time to fracture union was statistically less in SCP group 5.84 months as compared to 7.21 months in Ex–fix group. Also, 12 patients in Ex-fix group had to undergo a reoperation as compare to only 1 in SCP group. This led to higher cost of expenditure and higher duration of stay in Ex-fix group. AOFAS Score, Teeny and Wiss were better in SCP group as compared to Ex-fix group. Conclusion Highlighting the role Of LCP in Supracutaneous mode as a definitive and final surgery , thus reducing the financial and psychological implication of reoperations in open grade and tibial fractures which are seen in patients managed with Ex-fix in definitive mode or as an interval for secondary nailing, we recommend the use of routine use of SCP in such tibial fractures after thorough debridement and diligent handling of soft tissue.
{"title":"External Fixator vs. Locking Compression Plate in “Supracutaneous” Mode for Open Distal Tibial Fractures: A Comparison on Economics, Union, Functional Outcome and Complications","authors":"Rubinder Kaur, Abhishek Sharma, Sanjay Kumar Thakur, Manik Sehgal","doi":"10.25259/ijrsms-2022-2-11","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-2-11","url":null,"abstract":"Objectives Historically, in the pre-antiseptic era, there was a great fear of open tibial factors because of high incidence of infection eventually leading to amputation and in many cases septicemia and death. Despite improvements in surgical techniques in the last century, the optimum treatment for open type IIIa and Type II tibial farcture remains controversial. Literature available on use of Ex-fix as a definitive and permanent modality is very sparse and is not encouraging. In order to maintain biology of the fracture and to expedite the healing process many institutions and surgeons are using Locking compression plate as an external fixator which is fondly called as supracutaneous plating (SCP). Material and Methods The patients who had Gustilo and Anderson type II and IIIa # of distal Tibia were enrolled in this study. They were randomized into 2 groups. In one group (Ex-Fix) external fixator was applied in and in another group SCP was done. Four general indicators, including direct cost of hospitalization, first surgery time, time to full weight bearing, and time to complete union were compared between the groups. The functional outcome of the ankle was assessed. Presence of infection, Time to union was noted in both cases. Results Mean time to fracture union was statistically less in SCP group 5.84 months as compared to 7.21 months in Ex–fix group. Also, 12 patients in Ex-fix group had to undergo a reoperation as compare to only 1 in SCP group. This led to higher cost of expenditure and higher duration of stay in Ex-fix group. AOFAS Score, Teeny and Wiss were better in SCP group as compared to Ex-fix group. Conclusion Highlighting the role Of LCP in Supracutaneous mode as a definitive and final surgery , thus reducing the financial and psychological implication of reoperations in open grade and tibial fractures which are seen in patients managed with Ex-fix in definitive mode or as an interval for secondary nailing, we recommend the use of routine use of SCP in such tibial fractures after thorough debridement and diligent handling of soft tissue.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"358 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134915148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-11DOI: 10.25259/ijrsms-2023-3-15
Tej Gupta, Akshay Ashok Bawaskar, Parul Kamboj, Pratik Pandurang Gurav, Sanjay Rai
Objectives Hardware removals are among the commonly performed surgical procedures in orthopaedics, but they sometimes prove quite difficult. The purpose of our study was to evaluate the risk, benefit and drawbacks of asymptomatic implant removal based on patients’ desire. Materials and Methods A total of 105 patients who had been previously treated for a fracture and voluntarily wanted its removal and who did not report clinical indications or occasional regional pain were included in the study cohort. Results For the 105 patients surveyed, implant removals were performed in the leg (41 patients; 39%), the ankle joint (32 patients; 30%), the thigh (19 patients; 18%) and the forearm and the wrist (15 patients; 14%). The most common indication for removal was patients’ request in 66 (62.8%) cases. Altogether, 98 (93%) patients were satisfied because of the fulfilment of their desire, despite the instances of complication being frequent (32.8%). Conclusion In our study, we reported a surprisingly high rate of satisfied patients after surgical hardware removal once their requests for hardware removal were taken into consideration. However, it was closely associated with multiple risks. Therefore, judicious selection of actually eligible patients is highly recommended instead of the unqualified fulfilment of their requests for removal.
{"title":"Asymptomatic implant removal after fracture union based on request to remove. Is it worth considering, an Indian perspective?","authors":"Tej Gupta, Akshay Ashok Bawaskar, Parul Kamboj, Pratik Pandurang Gurav, Sanjay Rai","doi":"10.25259/ijrsms-2023-3-15","DOIUrl":"https://doi.org/10.25259/ijrsms-2023-3-15","url":null,"abstract":"Objectives Hardware removals are among the commonly performed surgical procedures in orthopaedics, but they sometimes prove quite difficult. The purpose of our study was to evaluate the risk, benefit and drawbacks of asymptomatic implant removal based on patients’ desire. Materials and Methods A total of 105 patients who had been previously treated for a fracture and voluntarily wanted its removal and who did not report clinical indications or occasional regional pain were included in the study cohort. Results For the 105 patients surveyed, implant removals were performed in the leg (41 patients; 39%), the ankle joint (32 patients; 30%), the thigh (19 patients; 18%) and the forearm and the wrist (15 patients; 14%). The most common indication for removal was patients’ request in 66 (62.8%) cases. Altogether, 98 (93%) patients were satisfied because of the fulfilment of their desire, despite the instances of complication being frequent (32.8%). Conclusion In our study, we reported a surprisingly high rate of satisfied patients after surgical hardware removal once their requests for hardware removal were taken into consideration. However, it was closely associated with multiple risks. Therefore, judicious selection of actually eligible patients is highly recommended instead of the unqualified fulfilment of their requests for removal.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136023273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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