569 results match your criteria gustilo type


Infection after Open Long Bone Fractures: Can we Improve on Prophylaxis?

J Surg Res 2021 Jul 16;268:33-39. Epub 2021 Jul 16.

Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address:

Introduction: Current standards recommend antibiotic prophylaxis administered after open fracture injury. The purpose of this study was to assess culture results in patients with open fracture-associated infections, hypothesizing that cultures obtained do not vary by Gustilo-Anderson (GA) classification.

Methods: We examined cultured bacterial species from patients with open long bone fractures that underwent irrigation and debridement at a Level 1 trauma center (2008-2016), evaluating our current and two hypothetical antibiotic protocols to assess whether they provided appropriate coverage. Read More

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Timing of Flap Coverage With Respect to Definitive Fixation in Open Tibia Fractures.

J Orthop Trauma 2021 Aug;35(8):430-436

Strong Memorial Hospital, Rochester, NY.

Objectives: We conducted a large, U.S wide, observational study of type III tibial fractures, with the hypothesis that delays between definitive fixation and flap coverage might be a substantial modifiable risk factor associated with nosocomial wound infection.

Design: A retrospective analysis of a multicenter database of open tibial fractures requiring flap coverage. Read More

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Which is the better choice for open tibial shaft fracture in overweight adolescent with open physis: A comparative study of external fixator plus elastic stable intramedullary nail versus external fixator alone.

Injury 2021 Jun 30. Epub 2021 Jun 30.

Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address:

Purpose: To compare the clinical outcomes of external fixator + elastic stable intramedullary nail (EF+ESIN) vs. external fixator (EF) in the treatment for open tibial shaft fracture in overweight adolescents.

Methods: Patients of open tibial shaft fractures younger than 14 years old with body weight over 50 Kg treated with EF + ESIN or EF at our institute from 2010 to 2018 were reviewed. Read More

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Open Pilon Fracture Postoperative Outcomes with Definitive Surgical Management Options: A Systematic Review and Meta-analysis.

Arch Bone Jt Surg 2021 May;9(3):272-282

Department of Trauma and Orthopaedics, Cambridge University Hospital, Addenbrookes Major Trauma Centre, Cambridge, UK.

Background: Pilon fractures represent one of the most surgically challenging fractures in orthopaedics. Different techniques exist for their management, with open reduction and internal fixation (ORIF) and External fixation (Ex-Fix) the most widely used. Whilst there is a plethora of data regarding these strategies for Pilon fractures as a whole, very limited data exists solely on the management of Pilon fractures. Read More

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Delayed debridement of open tibia fractures beyond 24 and 48 h does not appear to increase infection and reoperation risk.

Eur J Orthop Surg Traumatol 2021 Jun 30. Epub 2021 Jun 30.

Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.

Purpose: Surgical debridement is critical to the treatment of open tibia fractures, although the effects of delayed debridement have not been well-established. Other factors such as Gustilo-Anderson type, prompt initiation of antibiotics, and time to definitive closure may be more predictive of infection than time to surgery. We sought to determine the effect of a prolonged delay to surgical debridement with respect to infection and reoperation rates for open tibia fractures. Read More

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Open tibial shaft fracture in a boy with autism spectrum disorder treated using a ring external fixator: A case report.

Trauma Case Rep 2021 Aug 16;34:100502. Epub 2021 Jun 16.

Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, Japan.

Autism spectrum disorder covers a group of behaviorally defined disorders that may result in the patient having difficulty staying calm during medical treatments, due to anxiety-related overreactions. Tibial fractures are the third most common pediatric long-bone fracture. Conservative treatment is selected in many cases, but surgical treatment may be selected in cases of open fracture and no treatment policy has been established. Read More

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Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing.

Chin J Traumatol 2021 May 25. Epub 2021 May 25.

Orthopedics and Traumatology Clinic, Çankırı State Hospital, Çankırı, Turkey.

Purpose: In the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures. Read More

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Management of Grade 3C Compound Injury of Lower Limb with Floating Knee - Salvage versus Amputation (Case Series).

J Orthop Case Rep 2021 Feb;11(2):119-127

Department of Orthopaedic surgery, Sri Ramachandra Institute of Higher Education and Research Centre, Chennai, Tamil Nadu, India.

Introduction: Severe open injuries of limbs, especially of the femur and tibia when associated with vascular injuries, present major challenges in management. The decision to amputate or salvage can often be a difficult one even for experienced surgeons. Mangled lower extremity results due to high-energy trauma, especially due to motor vehicle accidents, and is defined as injury to three of the four systems in the extremity that is soft tissues, bone, vascular, and nerve. Read More

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February 2021

Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review.

Acta Orthop Belg 2021 Mar;87(1):85-92

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. Read More

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Treatment of high-energy intra-articular fractures of tibia with Ilizarov external fixator in adults: A tertiary centre experience.

Int J Clin Pract 2021 Jun 11:e14488. Epub 2021 Jun 11.

Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.

Objective: To evaluate the clinical and radiological outcomes of the Ilizarov fixator in the proximal and distal fractures of the tibia.

Materials And Methodology: This retrospective study reviewed 59 patients having high-energy intra-articular proximal and distal tibia fractures associated with severe soft-tissue injury, who were managed surgically with an Ilizarov fixator. The functional outcome was evaluated by using the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Association for the Study and Application of the Method of Ilizarov (ASAMI) Italy scoring system for tibial plateau and plafond fractures respectively. Read More

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Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients - A description of the technique and presentation of a case series.

Injury 2021 Jul 1;52 Suppl 3:S33-S37. Epub 2021 Jun 1.

Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil. Electronic address:

Introduction: Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. Read More

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Definitive fixation outcomes of open tibial shaft fractures: Systematic review and network meta-analysis.

J Orthop Trauma 2021 Mar 27. Epub 2021 Mar 27.

Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom. Department of Orthopaedic Surgery, The Royal National Orthopaedic Hospital, Stanmore, United Kingdom. Department of Orthopaedic Surgery, McMaster University, Ontario, Canada Department of Orthopaedic Surgery, Boston Medical Center, Boston, USA.

Objectives: To delineate if there were differences in outcomes between definitive fixation strategies in open tibial shaft fractures.

Data Sources: MEDLINE, EMBASE, CENTRAL, OpenGrey.

Study Selection: Randomized and Quasi-randomized studies analyzing adult patients (>18 years) with open tibial shaft fractures (AO-42), undergoing definitive fixation treatment of any type. Read More

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[Locking plate external fixation combined with membrane induction technology for the treatment of open and comminuted tibial fractures with bone defects].

Zhongguo Gu Shang 2021 May;34(5):400-5

Department of Orthopaedics, Chongqing Public Health Medical Center, Chongqing 400030, China.

Objective: To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects.

Methods: Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37. Read More

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Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures.

J Orthop Trauma 2021 06;35(6):e189-e194

Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY.

Objectives: (1) Evaluate intentional temporary limb deformation for closure of soft-tissue defects as a reconstruction strategy in open tibia fractures and (2) analyze the deformity parameters required for such reconstruction.

Design: Multicenter retrospective cohort.

Setting: Level I trauma center. Read More

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A Leg to Stand on: Trauma Center Designation and Association with Rate of Limb Salvage in Patients Suffering Severe Lower Extremity Injury.

J Am Coll Surg 2021 Jul 20;233(1):120-129.e5. Epub 2021 Apr 20.

Department of Plastic and Reconstructive Surgery, Loyola University Chicago, Maywood; Department of Surgery, Edward Hines Jr Veterans Administration Hospital, Hines, IL.

Background: Mangled extremities are one of the most difficult injuries for trauma surgeons to manage. We compare limb salvage rates for a limb-threatening lower extremity injuries managed at Level I vs Level II trauma centers (TCs).

Study Design: We identified all adult patients with a limb-threatening injury who underwent primary amputation or limb salvage (LS) using the American College of Surgeons (ACS) Trauma Quality Improvement Program database at ACS Level I vs II TCs between 2007 and 2017. Read More

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A Case of Reconstruction of a Type IIIc Open Tibial Fracture with Bone Loss and Warm Ischemia Time of 13 Hours: Quality of Life and Review of the Literature.

Am J Case Rep 2021 Apr 20;22:e929993. Epub 2021 Apr 20.

Department of Orthopedics, University Hospital, Patras Medical School, Patras, Greece.

BACKGROUND The management of open Gustilo IIIC fractures can be challenging even for experienced orthopedic surgeons. The decision between limb salvage and amputation is extremely difficult and the scoring systems do not seem to affect it significantly. Although ischemic time has been proven to be a major factor, attempts at reconstruction of limbs with ischemic time over 6 hours have been made in past decades. Read More

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Effect of Tourniquet Use During Surgical Treatment of Open Fractures.

J Bone Joint Surg Am 2021 May;103(10):860-868

University of Maryland School of Medicine, Baltimore, Maryland.

Background: We sought to evaluate whether tourniquet use, with the resultant ischemia and reperfusion, during surgical treatment of an open lower-extremity fracture was associated with an increased risk of complications.

Methods: This is a retrospective cohort study of 1,351 patients who had an open lower-extremity fracture at or distal to the proximal aspect of the tibia and who participated in the FLOW (Fluid Lavage of Open Wounds) trial. The independent variable was intraoperative tourniquet use, and the primary outcome measures were adjudicated unplanned reoperation within 1 year of the injury and adjudicated nonoperative wound complications. Read More

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Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report.

BMC Musculoskelet Disord 2021 Apr 7;22(1):338. Epub 2021 Apr 7.

Department of Orthopedic Trauma, Beijing Jishuitan Hospital, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.

Background: Chronic intercondylar fractures of the distal humerus with massive bone defects and severe comminution in the metaphysis are rare and complex injuries that are challenging for surgeons to treat, as reconstructing the triangular structure of the distal humerus is difficult and may have a severe impact on functional outcomes, especially in young patients, for whom total elbow arthroplasty is usually not a suitable option due to significant impairment in upper limb strength. Here, we report a patient in such scenario who was young and active and was treated by structural iliac bone autografting and internal fixation.

Case Presentation: A 26-year-old male patient experienced a major car accident and was diagnosed with an open fracture (Gustilo-Anderson type IIIB) of the right distal humerus with massive bone defects and severe intra-articular involvement, without neurovascular injuries or other associated injuries. Read More

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Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect.

Case Rep Orthop 2021 10;2021:8829158. Epub 2021 Mar 10.

Department of Orthopedic Surgery and Trauma, Hospital Saint-Antoine, Paris, France.

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. Read More

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Acute Compartment Syndrome in Type IIIB Open Tibial Shaft Fractures Utilising a Two-Stage Orthoplastic Approach.

J Orthop Trauma 2021 Mar 22. Epub 2021 Mar 22.

Department of Trauma & Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. Department of Trauma & Orthopaedics, Stanmore Hospital, London, United Kingdom. Department of Trauma & Orthopaedics, Southmead Hospital, Bristol, United Kingdom Department of Plastic Surgery, Southmead Hospital, Bristol, United Kingdom.

Objective: To determine the rate of acute compartment syndrome (ACS) in a series of patients with Gustilo-Anderson type IIIB open tibial shaft fractures that were treated using a specific two-stage orthoplastic protocol.

Design: Consecutive cohort study.Patients/Participants: Ninety-three (n =93) consecutive patients with a type IIIB open tibial shaft fracture (OTA/AO-42) treated utilizing a two-stage orthoplastic approach, between August 2015 and January 2018. Read More

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Delay in Initial Debridement for Open Tibial Fractures and Its Possible Impact on Patient Outcomes: A Single-Center Prospective Cohort Study.

JB JS Open Access 2021 Jan-Mar;6(1). Epub 2021 Mar 5.

Department of Orthopedic Surgery, Whiston Hospital, Prescot, United Kingdom.

The current consensus regarding the management of open fracture indicates that the initial debridement should be performed within the first 6 hours after injury. Unfortunately, in Pakistan, the emergency medical services are not well-established and patient arrival at the hospital is delayed the majority of the time. In this study, we present our experience with delayed surgical management of open tibial fractures. Read More

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Bomb blast: imaging findings, treatment and clinical course of extremity traumas.

BMC Emerg Med 2021 03 6;21(1):28. Epub 2021 Mar 6.

Department of Cardiovascular Surgery, University of Health Sciences-Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital, Mogadishu, Somalia.

Background: To describe the severity and types of blast-related extremity injuries and the presence of accompanying vascular injuries (VI) and amputation, and to identify the associated factors affecting the treatment management and clinical course.

Methods: The study included 101 patients with extremity injuries caused by a bomb explosion. The radiographs and computed tomography angiographies of the patients were evaluated in terms of injury patterns, presence of penetrating fragments and fractures, and localization (upper or lower extremity) and type (open or closed) of injury. Read More

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Management of Gustilo Type IIIC Injuries in the Lower Extremity.

Clin Plast Surg 2021 Apr 29;48(2):267-276. Epub 2021 Jan 29.

Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, 303 East 33rd Street, New York, NY 10016, USA.

Gustilo IIIC injuries of the lower extremity pose a significant challenge to the reconstructive surgeon. Key principles include early vascular repair and serial debridement followed by definitive coverage within 10 days. Primary reconstructive options following vascular repair include the anterolateral thigh flap or the latissimus dorsi muscle flap. Read More

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[Treatment of open middle and lower tibial fractures with bridge link combined fixation system external by means of external fixation].

Zhongguo Gu Shang 2021 Feb;34(2):148-52

Department of Orthopaedics, the Seventh People's Hospital of Changzhou, Changzhou 213011, Jiangsu, China.

Objective: To explore clinical effect of bridge-link combined fixation system(BCFS) in treating open middle and lower tibial fractures by external fixation.

Methods: From October 2016 to September 2017, 11 patients with open middle and lower tibial fractures were treated with BCFS by external fixation, including 7 males and 4 females aged from 23 to 65 years old with an average of 44.2 years old;the course of disease ranged from 7 to 10 days. Read More

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February 2021

Free tissue versus local tissue: A comparison of outcomes when managing open tibial diaphyseal fractures.

Injury 2021 Jun 11;52(6):1625-1628. Epub 2021 Feb 11.

Southmead Hospital, North Bristol NHS Trust, City of Bristol, UK. Electronic address:

Introduction: Open lower extremity fractures pose a challenge for treating surgeons. All surgical strategies have the common aim to facilitate fracture healing. Fracture union, however, should be critically considered in the context of functional recovery and not in isolation. Read More

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A novel low-profile external skeletal fixator for type IIIB open tibial fractures: A biomechanical and clinical pilot study.

J Chin Med Assoc 2021 May;84(5):528-535

Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan, ROC.

Background: Although external fixator is standard for managing staged treatment of open tibial fracture, the main disadvantage of this device is too bulky to be tolerated by most patients for longtime use. The purposes of this pilot study were to compare the biomechanical properties of a novel low-profile external fixator (LP-ESF) with a traditional ESF and also to evaluate its performance in patients with Gustilo type IIIb tibial open fractures.

Methods: A prospective clinical pilot study started from January 2015 to December 2017, and 18 patients with Gustilo type IIIb open tibial fractures underwent the fixation with a novel LP-ESF system. Read More

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Management of a Severe Degloving Injury With a Type 2 Open Tibia Fracture Using Negative Pressure Wound Therapy With Instillation and Dwell Time.

Wounds 2020 Dec;32(12):E110-E113

Department of Orthopedic Surgery and Trauma, Regional Hospital of Orleans, Orleans, France.

Introduction: Severe lower extremity trauma cases are challenging for most orthopedic surgeons if a degloving injury with open fracture is associated, especially in the elderly population. The management of the soft tissue is essential for bone union and reduction of infection.

Case Report: The authors present the case of an 87-year-old female admitted to their department after a road accident in which she sustained an open fracture of the distal tibia classified as Gustilo-Anderson Type II, a closed fracture of the lateral malleoli, and a degloving of the posterior and lateral aspect of the left leg. Read More

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December 2020

Traumatic Obturator Dislocation of the Hip Joint Associated with Greater Trochanter Fracture: A Case Report.

Orthop Surg 2021 Apr 28;13(2):673-677. Epub 2021 Jan 28.

Department of Orthopaedics, Panzhihua Municipal Central Hospital, Panzhihua, China.

Background: Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow-up results were achieved. Read More

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The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania.

Plast Reconstr Surg Glob Open 2020 Dec 21;8(12):e3272. Epub 2020 Dec 21.

Division of Plastic and Reconstructive Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, Calif.

Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear.

Methods: We examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2. Read More

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December 2020

Early injection of autologous bone marrow concentrates decreases infection risk and improves healing of acute severe open tibial fractures.

Injury 2020 Dec 31. Epub 2020 Dec 31.

University Paris East Hôpital Henri Mondor, 94010 Creteil, France.

Introduction: Open fractures are at risk of nonunion; surgeons are reluctant to propose early standard bone grafting after open fractures, preferring to wait in order to adequately assess the facture status of infection. Bone marrow contains mesenchymal stem cells (MSCs) and granulocyte and macrophage precursors identified in vitro as colony forming units-granulocyte macrophage (CFU-GM), both of which have a prophylactic action against infection. We therefore tested the hypothesis that early injection of bone marrow concentrate would be useful in these fractures. Read More

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December 2020