Factors that Influence Soft-tissue Injury in Fractures of the Distal Tibia | ||
The Archives of Bone and Joint Surgery | ||
مقاله 3، دوره 9، شماره 2، خرداد 2021، صفحه 152-157 اصل مقاله (933.62 K) | ||
نوع مقاله: RESEARCH PAPER | ||
شناسه دیجیتال (DOI): 10.22038/abjs.2020.41667.2126 | ||
نویسندگان | ||
Monica Rubio-Yanchuck1؛ Juan C. Rubio-Suarez2؛ E. Carlos Rodriguez-Merchan* 2 | ||
1Department of Plastic and Reconstructive Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain | ||
2Department of Orthopaedic Surgery; La Paz University Hospital-IdiPaz, Madrid, Spain | ||
چکیده | ||
Background: Soft tissue injury associated with fractures of the distal tibia is a predictive factor for a poor prognosis. The purpose of this study was to investigate factors associated with the need for a flap coverage after distal tibial fracture, and whether there was a difference in functional outcomes between patients with flap coverage or no flap coverage for a distal tibial fracture. Methods: All fractures of the distal tibia treated in our department between 2010 and 2017 were reviewed. The functional result was assessed using the SF-36 Quality of Life Questionnaire, the Visual Analog Scale (VAS) when walking and the AOFAS scale (American Orthopedic Foot and Ankle Society). Results: 132 distal tibia fractures were reviewed, of which 51 required soft tissue flap reconstruction, which was associated with open fractures (p <0.001, OR 5.25), high energy trauma (p <0.001, OR 1.7)), the use of external fixation (p <0.001, OR 12.5) and the presence of vascular alterations on the Angio-CT scan (p <0.001). No significant differences were found in any of the scales that assessed the functional results between the group of patients who required soft tissue flap reconstruction and the group of patients who did not. Conclusion: We found that the need for a soft tissue flap was associated with the following parameters: open fracture, high energy of trauma, presence of skin necrosis, the use of external fixation and the existence of vascular injury. In relation to functional results, differences were not found between the group that needed coverage with a flap and the one that did not. Level of evidence: III | ||
کلیدواژهها | ||
Distal tibia؛ Fractures؛ Soft-tissue flap coverage؛ Soft tissue injury | ||
مراجع | ||
1. Zelle BA, Dang KH, Ornell SS. High-energy tibial pilon fractures: an instructional review. Int Orthop. 2019:1-2. 2. Rb G. 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):453-8. 3. Dickson KF, Katzman S, Paiement G. The importance of the blood supply in the healing of tibial fractures. Contemp Orthop. 1995; 30(6):489. 4. Menck J, Bertram C, Lierse W. Sectorial angioarchitecture of the human tibia. Cells Tissues Organs. 1992; 143(1):67-73. 5. Tarkin IS, Sop A, Pape HC. High-energy foot and ankle trauma: principles for formulating an individualized care plan. Foot Ankle Clin. 2008; 13(4):705-23. 6. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006; 20(1):76-9. 7. Tarkin IS, Siska PA, Zelle BA. Soft tissue and biomechanical challenges encountered with the management of distal tibia nonunions. Orthop Clin North Am. 2010; 41(1):119-26. 8. Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg. 2011; 19(10):612-22. 9. Erichsen JL, Andersen PI, Viberg B, Jensen C, Damborg F, Froberg L. A systematic review and meta-analysis of functional outcomes and complications following external fixation or open reduction internal fixation for distal intra-articular tibial fractures: an update. Eur J Orthop Surg Traumatol. 2019; 29(4):907-17. 10. Bear J, Rollick N, Helfet D. Evolution in management of tibial pilon fractures. Curr Rev Musculoskelet Med. 2018; 11(4):537-45. 11. Molepo M, Barnard AC, Birkholtz F, Tetsworth K, Glatt V, Hohmann E. Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator. Eur J Orthop Surg Traumatol. 2018; 28(8):1617-24. 12. Scaglione M, Celli F, Casella F, Fabbri L. Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases. Musculoskelet Surg. 2019; 103(1):83-9. 13. Vaienti E, Schiavi P, Ceccarelli F, Pogliacomi F. Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome. Int Orthop. 2019; 43(1): 201-7. 14. Dang KH, Ornell SS, Huynh RA, DeLeon JC, Pesek R, Karia RA. Early clinical and radiographic outcomes of a mini-fragment, low profile plating system in tibial plafond fractures. Injury. 2019; 50(10):1773-80. 15. Silluzio N, De Santis V, Marzetti E, Piccioli A, Rosa MA, Maccauro G. Clinical and radiographic outcomes in patients operated for complex open tibial pilon fractures. Injury. 2019; 50:S24-8. 16. Malige A, Yeazell S, Nwachuku C. Surgical fixation of pilon injuries: a comparison of the anterolateral and posterolateral approach. Arch Orthop Trauma Surg. 2019; 139(9):1179-85. 17. Misir A, Kizkapan TB, Yildiz KI, Uzun E, Ozcamdalli M. Traction radiographs versus CT in the evaluation of fracture morphology and consecutive treatment decisions in OTA/AO 43C3 fractures. Injury. 2019; 50(2):332-6. 18. Gates CB, Karthikeyan T, Fu F, Huard J. Regenerative medicine for the musculoskeletal system based on muscle-derived stem cells. J Am Acad Orthop Surg. 2008; 16(2):68-76. 19. Sirkin M, Sanders R, DiPasquale T, Herscovici Jr D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 2004; 18(8):S32-8. 20. Krettek C, Bachmann S Pilon fractures. Part 2: Repositioning and stabilization technique and complication management Chirurg. 2015; 86(2):187-201. 21. LeBus GF, Collinge C. Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures. J Orthop Trauma. 2008; 22(1):16-22. 22. Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006; 117(7S):261S-93S. 23. Carbonell-Escobar R, Rubio-Suarez JC, Ibarzabal-Gil A, Rodriguez-Merchan EC. Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation. J Clin Orthop Trauma. 2017; 8(4):332-8. | ||
آمار تعداد مشاهده مقاله: 702 تعداد دریافت فایل اصل مقاله: 448 |