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Abstract
ABSTRACT
Introduction. The annual incidence of open long-bone fractures is estimated to 11.5 per 100,000 habitants; and they occur in tibial diaphysis for a quarter of cases [1,2]. Their management is a challenge for the orthopedic surgeon. In order to avoid infection, the treatment of open limb fractures is a surgical emergency. Objective. The aim of this study was to assess the results of primary intramedullary nailing after 6 hours of open Gustilo I and II diaphyseal fractures of femur and tibia. Materials and methods. Between January 2021 and December 2023, a retrospective study was conducted. Patients over 15 years admitted for open Gustilo I and II diaphyseal fracture of the femur and/or tibia in whom locked intramedullary nailing had been performed after initial debridement were included. The study involved 35 patients, 26 (74.3%) men and 9 (25.7%) women. The mean age was 35.4 (17-56) years. There were 30 (85.7%) tibial diaphyseal fractures and 5 (14.3%) femoral fractures. The wound was classified as Gustilo II in 23 (65.7%) cases and Gustilo I in 12 (34.3%). Debridement was performed in 37.1% of cases between 12 and 24 hours. An unreamed intramedullary nailing was performed after debridement. All patients were followed up for an average w of 20 (12 - 24) months. Results. Wound healing was achieved in 24 (68%) patients after 21 days. We observed 2 skin necrosis. Bone healing was achieved in 33 (94.3%) patients within an average of 110 (100-150) days. We observed 2 (5.7%) septic pseudarthrosis. Conclusion. Primary intramedullary nailing of open Gustilo I and II fractures of the tibia and femur provide consolidation with a low rate of infectious complications.
RÉSUMÉ
Introduction. L'incidence annuelle des fractures ouvertes des os longs est estimée à 11,5 pour 100 000 habitants ; elles concernent la diaphyse tibiale dans un quart des cas [1,2]. Leur prise en charge est un défi pour le chirurgien orthopédiste. Afin d'éviter l'infection, le traitement des fractures ouvertes est une urgence chirurgicale. Objectif. Le but de cette étude était d'évaluer les résultats de l'enclouage intramédullaire primaire après 6 heures de fractures diaphysaires ouvertes de Gustilo I et II du fémur et du tibia. Matériels et méthode. Entre janvier 2021 et décembre 2023, une étude rétrospective a été réalisée. Les patients de plus de 15 ans admis pour une fracture diaphysaire ouverte de Gustilo I et II du fémur et/ou du tibia chez qui un enclouage intramédullaire verrouillé avait été réalisé après débridement initial ont été inclus. L'étude a porté sur 35 patients, 26 (74,3 %) hommes et 9 (25,7 %) femmes. L'âge moyen était de 35,4 ans (17-56). Il y avait 30 (85,7%) fractures diaphysaires tibiales et 5 (14,3%) fractures fémorales. La plaie a été classée comme Gustilo II dans 23 (65,7%) cas et Gustilo I dans 12 (34,3%) cas. Un débridement a été effectué dans 37,1% des cas entre 12 et 24 heures. Un enclouage intramédullaire non fraisé a été réalisé après le débridement. Tous les patients ont été suivis pendant une durée moyenne de 20 (12 - 24) mois. Résultats. La cicatrisation a été obtenue chez 24 (68%) patients après 21 jours. Nous avons observé 2 nécroses cutanées. La guérison osseuse a été obtenue chez 33 (94,3 %) patients dans un délai moyen de 110 (100-150) jours. Nous avons observé 2 (5,7%) pseudarthroses septiques. Conclusion. L'enclouage intramédullaire primaire des fractures ouvertes de Gustilo I et II du tibia et du fémur permet une consolidation avec un faible taux de complications infectieuses.
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References
- Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29:529-34
- Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults: a 15-year review. Injury. 2012; 43(6):891-897
- Friedrich PL. Die aseptische Versorgung frischer Wunden, unter Mittheilung von Thier- Versuchen u¨ber die Auskeimungszeit von Infectionserregern in frischen Wunden. Scientific pamphlet 1896.
- Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58(4):453-458.
- Patzakis MJ,Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40
- Tornetta P , Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade- IIIb open tibial fractures: a prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994; 76(1):13-19.
- Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg 2006; 88 B: 281-89.
- Henley MB, Chapman JR, Agel J, Harvey EJ Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998; 12(1):1-7.
- Agrawal A, Devisingh Chauhan V, Maheshwari RK ,an Kumar Juyal A. Primary Nailing in the Open Fractures of the Tibia-Is it worth? J. Clin Diagn. Res. 2013; 7: 1125-1130.
- Ryan S, Pugliano V. Controversies in Initial Management of Open Fractures. Scand J Surg 2013. 103: 132–37,
- Minehara H, Maruo A, Amadei R, Contini A, Braile A, Kelly M and al. Open fractures: Current treatment perspective Ota int 2023 ;6(3):e240
- Halawi M, Morwood M, Acute Management of Open Fractures: An Evidence-Based Review Orthopedics. 2015; 38(11):1025- 33.
- Schenker M, Yannascoli S, , Baldwin K, Ahn J, Mehta S. Does Timing to Operative Debridement Affect Infectious Complications in Open Long-Bone Fractures? A Systematic Review. J Bone Joint Surg Am. 2012;94:1057-64
References
Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury. 1998;29:529-34
Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults: a 15-year review. Injury. 2012; 43(6):891-897
Friedrich PL. Die aseptische Versorgung frischer Wunden, unter Mittheilung von Thier- Versuchen u¨ber die Auskeimungszeit von Infectionserregern in frischen Wunden. Scientific pamphlet 1896.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976; 58(4):453-458.
Patzakis MJ,Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40
Tornetta P , Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade- IIIb open tibial fractures: a prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994; 76(1):13-19.
Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J Bone Joint Surg 2006; 88 B: 281-89.
Henley MB, Chapman JR, Agel J, Harvey EJ Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998; 12(1):1-7.
Agrawal A, Devisingh Chauhan V, Maheshwari RK ,an Kumar Juyal A. Primary Nailing in the Open Fractures of the Tibia-Is it worth? J. Clin Diagn. Res. 2013; 7: 1125-1130.
Ryan S, Pugliano V. Controversies in Initial Management of Open Fractures. Scand J Surg 2013. 103: 132–37,
Minehara H, Maruo A, Amadei R, Contini A, Braile A, Kelly M and al. Open fractures: Current treatment perspective Ota int 2023 ;6(3):e240
Halawi M, Morwood M, Acute Management of Open Fractures: An Evidence-Based Review Orthopedics. 2015; 38(11):1025- 33.
Schenker M, Yannascoli S, , Baldwin K, Ahn J, Mehta S. Does Timing to Operative Debridement Affect Infectious Complications in Open Long-Bone Fractures? A Systematic Review. J Bone Joint Surg Am. 2012;94:1057-64