ABSTRACT
Objective To report the clinical efficacy of Kirschner wire combined with external fixator in the treatment of open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics.Methods A case series study was done on the clinical data of 15 open comminuted distal tibiofibular fractures which had been treated with kirschner wire combined with external fixation from January 2015 to August 2018 at Department of Orthopedics,Affiliated Hospital to Logistics College of Chinese People's Armed Police.They were 12 men and 3 women,aged from 27 to 62 years (mean,46.5 years).By the Gustilo classification,there were one case of type Ⅰ,4 cases of type Ⅱ,7 cases of type Ⅲ A,2 cases of type ⅢB and one case of type ⅢC.All the patients were treated with emergency debridement,tibial fixation using external fixator and fibular fixation using kirschner wire,followed by vacuum sealing drainage(VSD).Effective anti-inflammatory and other comprehensive treatments were given postoperatively.Regular follow-up was conducted to observe fracture healing and complications like osteomyelitis and bone disconnection.At the final follow-up,the American Orthopaedic Foot Ankle Society (AOFAS) ankle-hindfoot scale was used to evaluate the ankle function.Results All the patients were followed up for 12 to 18 months (mean,12.8 months).Primary bone union was achieved in 13 cases (86.7％),delayed healing observed in one case (6.7％) and bone nonunion in one case (6.7％).No osteomyelitis occurred.By the AOFAS ankle-hindfoot scale,the ankle function was rated as excellent in 9 cases,as good in 4,as fair in one and as poor in one.Conclusions For patients with open comminuted distal tibiofibular fracture,treatment should be conducted according to the concept of damage control orthopaedics.After early thorough debridement,the tibia should be fixated using external fixator and the fibula using kirschner wire,followed by VSD,leading to economical cost and satisfactory clinical efficacy.
ABSTRACT
<p><b>OBJECTIVE</b>To retrospectively explore the effects of damage control orthopaedics concept on coagulation and curative effects in unstable pelvic fractures and multiple fractures of limbs.</p><p><b>METHODS</b>From March 2014 to December 2015, 40 patients with unstable pelvic fractures and limbs multiple fractures in treatment group included 22 males and 18 females with an average age of (39.00±4.12) years old were treated with the damage control orthopaedics concept, the ISS score was (25.36±10.81) on average;Other 40 patients with the same trauma in conventional group included 25 males and 15 females with an average age of (38.00±3.24) years old were treated with conventional method from January 2012 to January 2014 served as control, the average ISS score was 26.56±11.44. Matta criteria and Majeed function standard were used respectively to evaluate the fracture reduction and therapeutic effects postoperatively. Coagulation function on the 7th day postoperatively was compared between two groups.</p><p><b>RESULTS</b>All patients were followed up for 6 to 24 months. According to Matta criteria, the fracture reduction of the treatment group and the conventional group were (7.38±5.09) mm and (10.11±6.53) mm, respectively (<0.05). Majeed functional results of the treatment group and the conventional group were (86.12±6.84) points and (77.53±8.30) points, respectively (<0.05). On the 7th day after surgery, PT, APTT, TT of the treatment group were significantly higher than that of the control group;and Fib of the treatment group was also significantly lower than that of the conventional group(<0.05).</p><p><b>CONCLUSIONS</b>The concept of damage control orthopaedics could effectively improve coagulation function of the patients with unstable pelvic fractures and limbs multiple fractures, thus are beneficial to the functional recovery as well as improve the curative effect postoperatively.</p>