371 results match your criteria management gustilo


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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Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review.

Br Med Bull 2021 Jul 5. Epub 2021 Jul 5.

Department of Trauma & Orthopaedics, Trauma Fellow, John Radcliffe Hospital Oxford, FRCS(T&O), Headley Way, Headington, Oxford OX3 9DU, UK.

Introduction: Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons.

Sources Of Data: We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures.

Areas Of Agreement And Controversy: Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. Read More

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The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis.

Diagnostics (Basel) 2021 Jun 2;11(6). Epub 2021 Jun 2.

Group for Academic Plastic Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK.

Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients' lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures. Read More

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Outcomes following the delayed management of open tibial fractures.

Injury 2021 Jun 2. Epub 2021 Jun 2.

Trauma & Orthopaedic Department, University Hospital Southampton, Tremona Road, Southampton SO16 6YD United Kingdom. Electronic address:

Aims: National guidelines set standards for the definitive management of open fractures within 72 h. This study aims to investigate our outcomes where this timeline was unachievable for most cases due to a split-site orthoplastic service.

Patients & Methods: 116 consecutive Gustilo-Anderson grade IIIB & IIIC open tibial fractures presenting to our major trauma centre (MTC) between September 2012 and April 2018 were reviewed. 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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Orthoplastic management of open tibial fractures in children : a consecutive five-year series from a paediatric major trauma centre.

Bone Joint J 2021 Jun;103-B(6):1160-1167

Bristol Royal Hospital for Children, Bristol, UK.

Aims: Open tibial fractures are limb-threatening injuries. While limb loss is rare in children, deep infection and nonunion rates of up to 15% and 8% are reported, respectively. We manage these injuries in a similar manner to those in adults, with a combined orthoplastic approach, often involving the use of vascularised free flaps. 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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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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Risk factors for treatment failure of fracture-related infections.

Injury 2021 Jun 1;52(6):1351-1355. Epub 2021 Apr 1.

R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA. Electronic address:

Objective: Infection after fracture fixation is a potentially devastating outcome, and surgical management is frequently unsuccessful at clearing these infections. The purpose of this study is to determine if factors can be identified that are associated with treatment failure after operative management of a deep surgical site infection.

Methods: We retrospectively reviewed the billing system at a Level I trauma center between March 2006 and December 2015. 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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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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Ankle arthrodesis using the Taylor Spatial Frame for the treatment of infection, extruded talus and complex pilon fractures.

Injury 2021 Apr 4;52(4):1028-1037. Epub 2021 Feb 4.

Limb Reconstruction Service, Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, CB2 0QQ, Cambridge, Cambridgeshire, United Kingdom. Electronic address:

Introduction: The treatment of complex pilon fractures and talus fracture-dislocations present several challenges, like avoiding infection, achieving union, management of bone loss and function preservation.

Methods: Retrospective cohort review of fourteen patients who underwent ankle arthrodesis (AA) using the Taylor Spatial Frame (TSF) after pilon and talus fracture-dislocations. Ten tibiocalcaneal (TC) and four tibiotalar (TT) fusions were performed. Read More

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Unique closure of Gustilo IIIA fracture with a hard-to-heal lower extremity wound.

J Wound Care 2021 Feb;30(Sup2):S24-S27

2 Medical Affairs, MiMedx Group, Inc., Marietta, GA.

Consistently achieving wound closure requires a broad understanding of wound physiology, anatomy and wound healing phases. The multifaceted principles of wound closure are comprised of: perfusion evaluation; diabetes control; nutritional optimisation; infection control; mechanical stress avoidance; oedema management; wound bed preparation; and community care. Optimisation of each element is crucial to timely and durable resolution of acute and hard-to-heal wounds. Read More

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February 2021

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

Low Adherence to Recommended Guidelines for Open Fracture Antibiotic Prophylaxis.

J Bone Joint Surg Am 2021 04;103(7):609-617

University of Maryland School of Medicine, Baltimore, Maryland.

Background: Prompt administration of antibiotics is a critical component of open fracture treatment. Traditional antibiotic recommendations have been a first-generation cephalosporin for Gustilo Type-I and Type-II open fractures, with the addition of an aminoglycoside for Type-III fractures and penicillin for soil contamination. However, concerns over changing bacterial patterns and the side effects of aminoglycosides have led to interest in other regimens. Read More

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Management of Open Calcaneal Fractures with Medial Wounds by One-Stage Sequential Reduction and Frame Structure Fixation Using Percutaneous Kirschner Wires.

Orthop Surg 2021 Feb 5;13(1):225-236. Epub 2021 Jan 5.

Department of Second Orthopaedic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China.

Objective: To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one-stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires.

Methods: A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type-II and seven type-IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Read More

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February 2021

Does malrotation following MIPO treatment of distal tibia metaphyseal fractures effect the functional results of the ankle and knee joints?

J Orthop Trauma 2020 Dec 31;Publish Ahead of Print. Epub 2020 Dec 31.

Ankara City Hospital, Department of Orthopedics and Traumatology, Ankara / TURKEY Ankara City Hospital, Department of Radiology, Ankara/TURKEY.

Objectives: To investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores.

Design: Prospectively collected data was retrospectively analyzed for this study.

Setting: Level III academic trauma center. Read More

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December 2020

One-stage combined "fix and flap" approach for complex open Gustilo-Anderson IIIB lower limbs fractures: a prospective review of 102 cases.

Arch Orthop Trauma Surg 2021 Jan 3. Epub 2021 Jan 3.

Consultant Trauma and Orthopaedics, Manchester University NHS Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.

Background: Management of open fractures is challenging and requires a multidisciplinary team approach. This study aims to evaluate outcomes of open Gustilo-Anderson IIIB fractures managed at a single Ortho-Plastic centre following One-stage "Fix and Flap" approach.

Methods: Prospective data review for patients presenting with Gustilo-Anderson IIIB Fractures to our centre and managed with one-stage "Fix and Flap" approach. Read More

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January 2021

The COVID-19 Pandemic: The effect on open lower limb fractures in a London major trauma centre - a plastic surgery perspective.

Injury 2021 Mar 11;52(3):402-406. Epub 2020 Dec 11.

Department of Plastic and Reconstructive Surgery, The Royal London Hospital, Barts Health NHS Trust.

Background: COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC). Read More

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Reliability of S.A.R.A. (sterilization and reimplantation autograft) technique in long bone open fractures.

J Biol Regul Homeost Agents 2020 Jul-Aug;34(4 Suppl. 3):223-230. Congress of the Italian Orthopaedic Research Society

Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.

The reimplantation of small or large extruded bone segments is one of the most complex clinical management scenarios in the treatment of open fractures. No consensus exists regarding the efficiency of this technique. The aim of the study was to analyse the clinical and radiological outcomes of Sterilization and Reimplantation Autograft (S. Read More

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January 2021

Extended Antibiotic Coverage in the Management of Type II Open Fractures.

Surg Infect (Larchmt) 2020 Oct 16. Epub 2020 Oct 16.

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Responsible antibiotic stewardship requires surgeons treating open fractures to use the narrowest appropriate antibiotic coverage possible to prevent infection. Because inter-observer agreement about the application of the Gustilo-Anderson open fracture classification is moderate at best, antibiotic selection can be overly aggressive. The purpose of this study was to evaluate the outcomes of Type II open fractures treated with gram-positive coverage only (GP) versus broad-spectrum antibiotic coverage (BS) with piperacillin-tazobactam (PT). Read More

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October 2020

The Vacuum-Assisted Closure Device Increases Value in the Treatment of Gustilo Grade IIIb Open Tibia Fractures in Children.

Cureus 2020 Sep 2;12(9):e10194. Epub 2020 Sep 2.

Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.

Background Wound management associated with Gustilo grade IIIb open tibia fractures in children often requires muscle flaps, skin grafts, and amputations. The purpose of this study is to report the outcomes and complications of vacuum-assisted closure (VAC) treatment, as well as discuss its role in optimizing value when treating these injuries. Methods A retrospective review of medical records and imaging studies was performed from 2008-2015. Read More

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September 2020

Successful treatment of an open tibial fracture in a 102-year-old woman: a case report.

J Rural Med 2020 Oct 1;15(4):221-224. Epub 2020 Oct 1.

Department of Orthopaedic Surgery, University of Tsukuba, Japan.

As the average life expectancy is increasing, the number of patients aged >100 years who have fragility fractures will increase in the future. In female patients, the incidence of open fractures increases with age. We present the case of a 102-year-old woman with open tibial and fibular diaphyseal fractures (Gustilo-Anderson classification type IIIb) treated with temporary external fixation, advancement flap, and negative pressure wound therapy in the first-stage surgery and treatment, and open reduction and internal fixation with skin grafting in the second-stage surgery. Read More

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October 2020

Open Tibial Shaft Fractures: Treatment Patterns in Latin America.

J Bone Joint Surg Am 2020 Nov;102(22):e126

Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California.

Background: Open tibial shaft fractures are an important source of disability in Latin America. High-income countries (HICs) worldwide have established standardized treatment protocols for open tibial fractures, but less is known about their treatment in middle-income countries (MICs) in Latin America. This survey of Latin American orthopaedic surgeons characterizes open tibial fracture treatment patterns. Read More

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November 2020

Definitive management of open pilon fractures with fine wire fixation.

Injury 2020 Nov 25;51(11):2717-2722. Epub 2020 Aug 25.

Department of Trauma And Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom. Electronic address:

Introduction: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines alongside a treatment protocol which consisted of early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with the use of a Fine Wire Fixator.

Material And Methods: We conducted a retrospective analysis of open pilon fractures treated between 2014 and 2019. Read More

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November 2020

Management Of Segmental Fracture Of Tibia Treated By Ilizarov External Fixation.

J Ayub Med Coll Abbottabad 2020 Jul- Sep;32(3):291-294

Department of Orthopaedic Surgery & Traumatology, Liaquat university of Medical & Health Sciences Jamshoro, Sindh, Pakistan.

Background: Tibial shaft segmental fractures are mostly occurring due to a high-energy trauma that produces a severe soft-tissue injury and resulting an excessive frequency of open and closed segmental fractures, and needs effective stable management. The objective of the study was to evaluate the functional outcome and union time in segmental tibial fracture treated with Ilizarov method.

Methods: This prospective Qausi-experimental study was carried out from March 2014 to February 2018. Read More

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December 2020

The Masquelet technique combined with the muscle flap for use in emergency management of acute Gustilo type III trauma of the lower limb with segmental bone loss:Case series.

Int J Surg 2020 Sep 30;81:85-93. Epub 2020 Jul 30.

Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China. Electronic address:

Background: Gustilo-Anderson type III traumas have been described as high-energy injuries with severe bone defects and extensive soft tissue damage, which remain a challenging entity, due to an inherent risk of infection, nonunion and even amputation. The emergency management of such severe trauma presents additional difficulties. Our study attempts to retrospectively evaluate the Masquelet technique combined with the muscle flap for the management of Gustilo type III trauma of the lower limb with segmental bone loss in emergencies and assess key points of success in this technique. Read More

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September 2020