Charles Zierenberg García, David Beaton Comulada, José Carlos Pérez López, Alfredo Lamela Domenech, Gabriella Rivera Ortiz, Héctor M González Montalvo, Pedro J Reyes-Martínez
{"title":"急性缩短和再延长治疗开放性胫骨骨折伴14公分及以上严重骨缺损和广泛的软组织损失。","authors":"Charles Zierenberg García, David Beaton Comulada, José Carlos Pérez López, Alfredo Lamela Domenech, Gabriella Rivera Ortiz, Héctor M González Montalvo, Pedro J Reyes-Martínez","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>A traumatic event to the tibia with more than 14 cm of bone and\nsoft tissue loss represents a challenge to most orthopedic surgeons and is \nconsidered a limb-threatening condition. Few solutions are available in such \nclinical situations and among them is the acute shortening and re-lengthening of\nbone and soft tissue.</p><p><strong>Materials and methods: </strong>Our study presents the management of 7 patients\nwith grade III B open fractures (according to the Gustillo-Anderson\nclassification) of the tibia who underwent resection\nof all the devitalized tissues, acute limb shortening to close the defect,\napplication of an external fixator, and metaphyseal osteotomy for \nre-lengthening. The patient outcomes were based\non different parameters using the evaluation system established by Paley et al.</p><p><strong>Results: </strong>Results acquired during the study show an average bone loss of 19cm\n(with a minimum of 14 cm and a maximum of 31.50cm). The average time\nto full recovery of all patients was 19 months with a minimum of 14 months\nand a max of 34 months. Patient presented with excellent bony union and\nnone existent or small refractory leg length discrepancy and did not require\nbone grafts or free flaps. Complications that the patients had were contractures,\nwhich required secondary procedures such as Achilles tendon re-lengthening\nand recurrent infections.</p><p><strong>Discussion: </strong>Overall patients had excellent bone union and were able to \nperform activities of their daily living. The Ilizarov technique of compression-dis-\ntraction osteogenesis is an elegant treatment option that should be considered\nin patients suffering such traumatic events providing excellent bony union\nand good functional outcomes for the patient.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone\\nof 14 CMS or more and extensive soft tissue loss.\",\"authors\":\"Charles Zierenberg García, David Beaton Comulada, José Carlos Pérez López, Alfredo Lamela Domenech, Gabriella Rivera Ortiz, Héctor M González Montalvo, Pedro J Reyes-Martínez\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>A traumatic event to the tibia with more than 14 cm of bone and\\nsoft tissue loss represents a challenge to most orthopedic surgeons and is \\nconsidered a limb-threatening condition. Few solutions are available in such \\nclinical situations and among them is the acute shortening and re-lengthening of\\nbone and soft tissue.</p><p><strong>Materials and methods: </strong>Our study presents the management of 7 patients\\nwith grade III B open fractures (according to the Gustillo-Anderson\\nclassification) of the tibia who underwent resection\\nof all the devitalized tissues, acute limb shortening to close the defect,\\napplication of an external fixator, and metaphyseal osteotomy for \\nre-lengthening. The patient outcomes were based\\non different parameters using the evaluation system established by Paley et al.</p><p><strong>Results: </strong>Results acquired during the study show an average bone loss of 19cm\\n(with a minimum of 14 cm and a maximum of 31.50cm). The average time\\nto full recovery of all patients was 19 months with a minimum of 14 months\\nand a max of 34 months. Patient presented with excellent bony union and\\nnone existent or small refractory leg length discrepancy and did not require\\nbone grafts or free flaps. Complications that the patients had were contractures,\\nwhich required secondary procedures such as Achilles tendon re-lengthening\\nand recurrent infections.</p><p><strong>Discussion: </strong>Overall patients had excellent bone union and were able to \\nperform activities of their daily living. The Ilizarov technique of compression-dis-\\ntraction osteogenesis is an elegant treatment option that should be considered\\nin patients suffering such traumatic events providing excellent bony union\\nand good functional outcomes for the patient.</p>\",\"PeriodicalId\":75610,\"journal\":{\"name\":\"Boletin de la Asociacion Medica de Puerto Rico\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2016-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Boletin de la Asociacion Medica de Puerto Rico\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Boletin de la Asociacion Medica de Puerto Rico","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone
of 14 CMS or more and extensive soft tissue loss.
Introduction: A traumatic event to the tibia with more than 14 cm of bone and
soft tissue loss represents a challenge to most orthopedic surgeons and is
considered a limb-threatening condition. Few solutions are available in such
clinical situations and among them is the acute shortening and re-lengthening of
bone and soft tissue.
Materials and methods: Our study presents the management of 7 patients
with grade III B open fractures (according to the Gustillo-Anderson
classification) of the tibia who underwent resection
of all the devitalized tissues, acute limb shortening to close the defect,
application of an external fixator, and metaphyseal osteotomy for
re-lengthening. The patient outcomes were based
on different parameters using the evaluation system established by Paley et al.
Results: Results acquired during the study show an average bone loss of 19cm
(with a minimum of 14 cm and a maximum of 31.50cm). The average time
to full recovery of all patients was 19 months with a minimum of 14 months
and a max of 34 months. Patient presented with excellent bony union and
none existent or small refractory leg length discrepancy and did not require
bone grafts or free flaps. Complications that the patients had were contractures,
which required secondary procedures such as Achilles tendon re-lengthening
and recurrent infections.
Discussion: Overall patients had excellent bone union and were able to
perform activities of their daily living. The Ilizarov technique of compression-dis-
traction osteogenesis is an elegant treatment option that should be considered
in patients suffering such traumatic events providing excellent bony union
and good functional outcomes for the patient.