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Related Concept Videos

Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Acute Compartment Syndrome in Type IIIB Open Tibial Shaft Fractures Using a 2-Stage Orthoplastic Approach.

Khalid Al-Hourani1, Michael Stoddart2, Oliver Pearce3

  • 1Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

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|March 27, 2021
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This study found that a two-stage orthoplastic protocol effectively treated severe open tibial fractures, with no cases of acute compartment syndrome (ACS) developing. The protocol demonstrated a zero rate of ACS in patients with type IIIB open tibial shaft fractures.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Reconstructive Surgery

Background:

  • Gustilo-Anderson type IIIB open tibial shaft fractures are complex injuries requiring specialized treatment.
  • Acute compartment syndrome (ACS) is a serious complication that can arise from such fractures.
  • Orthoplastic protocols aim to manage these injuries comprehensively, addressing both skeletal and soft tissue defects.

Purpose of the Study:

  • To determine the incidence of acute compartment syndrome (ACS) in patients with type IIIB open tibial shaft fractures treated with a specific two-stage orthoplastic protocol.
  • To evaluate secondary outcomes including deep infection, arterial injury, nonunion, and flap failure.

Main Methods:

  • A consecutive cohort study included 93 patients with type IIIB open tibial shaft fractures treated between August 2015 and January 2018.
  • The intervention involved a two-stage orthoplastic approach: Stage 1 included early debridement and temporary internal fixation; Stage 2 involved definitive fixation and flap coverage.
  • The primary outcome was the rate of ACS, with secondary outcomes assessing complications like infection, arterial injury, nonunion, and flap failure.

Main Results:

  • Eighty-three patients were analyzed, with a median follow-up of 1.6 years.
  • No patients (0/83) developed acute compartment syndrome requiring fasciotomy or showed sequelae of missed ACS.
  • Secondary complications included deep infection (7.2%), nonischemic arterial injury (21.7%), nonunion (6.0%), and flap failure (4.8%). Diabetes was associated with deep infection and nonunion.

Conclusions:

  • The two-stage orthoplastic protocol, including early debridement, appears to prevent ACS in patients with type IIIB open tibial shaft fractures.
  • No adverse sequelae of missed compartment syndrome were observed in the study cohort.
  • The protocol is a viable option for managing these challenging fractures, though careful monitoring for other complications is warranted.