Résumé
Objective:To explore the effect of tension-reducing distraction of external fixators for limb wound closure.Methods:A retrospective case series study was made on data of 21 patients with refractory limb wounds admitted to 920th Hospital of Joint Logistics Support Force of PLA from January 2016 to July 2019. There were 15 males and 6 females，aged 11 to 56 years ［ （37.8 ± 11.2）years］. The lower-limb wounds were found in 15 patients and the upper-limb wound in 6 patients. The area of wound defect ranged from 1.2 cm × 1.0 cm to 22.0 cm × 17.1 cm. After debridement of the limb wound，the tension-reducing distraction of Ilizarov external fixators was used according to the shape and location of the wound. Distraction was applied at a rate of 1 mm/d starting at postoperative day 1 and the direction of distraction was adjusted according to the angle of skin closure of the trauma. The wound reduction distraction time and wound healing time were recorded. The wound healing score was used to evaluate wound healing at postoperative 5 days and 30 days. Complications were recorded according to the Paley classification. The wound survival curve was plotted to observe the time of wound tension reduction and traction and wound healing. The final wound healing was detected as well.Results:All patients were followed up for 3 to 9 months ［（4.5 ± 1.7）months］. The wounds were significantly reduced after reduction and distraction，with the reduction time of 6-23 days ［（7.8 ± 2.3）days］ and the wound healing time of 15-47 days ［（23.0 ± 3.3）days］. The wound healing score was （3.2 ± 0.9）points at postoperative 5 days and （0.7 ± 0.2）points at postoperative 30 days （ P < 0.05）. There were 15 problems，0 disorder，and 0 sequelae according to the Paley classification of complications. The wound survival curve showed the median time of reduction and distraction and wound healing was 16 days and 34 days，respectively. All patients showed wound healing without recurrence，of which 10 were healed directly，8 by implants and 3 by sutures. Conclusion:For patients with limb wounds difficult to be treated by flap coverage，the tension-reducing distraction of external fixators can effectively close the wound，fasten wound healing，shorten treatment period，and has fewer complications and a low recurrence rate.
Résumé
PURPOSE@#To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation.@*METHODS@#This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up.@*RESULTS@#Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome.@*CONCLUSION@#Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.