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European Journal of Trauma and Emergency Surgery

Published in:

01-08-2017 | Original Article

Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up

Authors: O. Tunali, Y. Saglam, H. I. Balci, A. Kochai, N. A. Sahbaz, O. A. Sayin, O. Yazicioglu

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2017

Abstract

Purpose

Salvage or amputation for grade 3C open fracture of tibia is not well responded question universally because of surgical innovations, cultural believes, difficulties in estimate the outcome, coasts, and different results in the literature. The aim of this study was to evaluate the surgical outcomes of Gustilo grade 3C open tibia fractures with at least two years follow-up in non-military adults.

Methods

Twenty-two non-military patients with a mean age of 31.1 were operated with grade 3c open fractures at tibia level in last 10 years in our clinic. We evaluated them retrospectively and asked about their daily life, pain, and if present, about the wish for secondary amputation. We also asked if they would prefer a first day amputation rather than their present status.

Results

Mean operation time after the injury was 13 h. Seven patients had nerve injury. Mean operation number was 3.5. Eight patients (%36) (all due to circulatory problem) had to have amputation. All patients treated with temporary unilateral external fixation than converted to circular external fixators when soft tissue healing was completed. Two patients were reoperated because of deformity. Four patients needed revision surgery because of non-union. At long term follow, we had osteomyelitis in one patient.

Conclusions

Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.

MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the lower extremity assessment project (LEAP). J Am Acad Orthop Surg. 2006;14:S205–10.CrossRefPubMed

Allen MJ, et al. Major vascular injuries associated with orthopaedic injuries to the lower limb. Ann R Coll Surg Engl. 1984;66(2):101–4.PubMedPubMedCentral

Howe HR Jr, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53(4):205–8.PubMed

DiChristina DG, et al. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. 1994;8(6):494–503.CrossRefPubMed

Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987;10(12):1781–8.PubMed

Helfet DL, et al. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res. 1990;256:80–6.

Russell WL et al. (1991) Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg. 1991;213(5):473–80; discussion 480-1.

Seekamp A, Kontopp H, Tscherne H. Hannover Fracture Scale ‘98–reevaluation and new prospects for an established score system. Unfallchirurg. 2001;104(7):601–10.CrossRefPubMed

Fodor L, et al. Mangled lower extremity: can we trust the amputation scores? Int J Burns Trauma. 2012;2(1):51–8.PubMedPubMedCentral

10.

Ware JE and Kosinski M., SF-36 Physical and Mental Health Summary Scales: A Manual for Users of Version 1, Second Edition. QualityMetric Incorporated; Lincoln, RI.: 2001a.

11.

Levy BA, et al. Screening for extermity arterial injury with the arterial pressure index. Am J Emerg Med. 2005;23(5):689–95.CrossRefPubMed

12.

Johansen K, et al. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991;31(4):515–9 (discussion 519-22).CrossRefPubMed

13.

Flint LM, Richardson JD. Arterial injuries with lower extremity fracture. Surgery. 1983;93(1 Pt 1):5–8.PubMed

14.

Modrall JG, Weaver FA, Yellin AE. Diagnosis and management of penetrating vascular trauma and the injured extremity. Emerg Med Clin North Am. 1998;16(1):129–44.CrossRefPubMed

15.

Mullenix PS, et al. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006;44(1):94–100.CrossRefPubMed

16.

Reber PU, et al. Selective use of temporary intravascular shunts in coincident vascular and orthopedic upper and lower limb trauma. J Trauma. 1999;47(1):72–6.CrossRefPubMed

17.

Glass GE, Pearse MF, Nanchahal J. Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm. J Plast Reconstr Aesthet Surg. 2009;62(5):571–9.CrossRefPubMed

18.

Drost TF, et al. Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity. J Trauma. 1989;29(10):1331–4.CrossRefPubMed

19.

Moniz MP, et al. Concomitant orthopedic and vascular injuries as predictors for limb loss in blunt lower extremity trauma. Am Surg. 1997;63(1):24–8.PubMed

20.

Rosental JJ, et al. Vascular injuries associated with fractures of the femur. Arch Surg. 1975;110(5):494–9.CrossRefPubMed

21.

Cakir O, et al. Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl. 2005;87(5):348–52.CrossRefPubMedPubMedCentral

22.

Ashworth EM, et al. Lower extremity vascular trauma: a comprehensive, aggressive approach. J Trauma. 1988;28(3):329–36.CrossRefPubMed

23.

McHenry TP, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma. 2002;53(4):717–21.CrossRefPubMed

24.

Iannacone WM, et al. Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation. J Trauma. 1994;37(3):446–51.CrossRefPubMed

25.

Kluger Y, et al. Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma. 1994;36(2):222–5.CrossRefPubMed

26.

Fowler J, et al. The importance of surgical sequence in the treatment of lower extremity injuries with concomitant vascular injury: a meta-analysis. Injury. 2009;40(1):72–6.CrossRefPubMed

27.

Kootstra G, et al. Femoral shaft fracture with injury of the superficial femoral artery in civilian accidents. Surg Gynecol Obstet. 1976;142(3):399–403.PubMed

28.

Bishara RA, et al. Improved results in the treatment of civilian vascular injuries associated with fractures and dislocations. J Vasc Surg. 1986;3(5):707–11.CrossRefPubMed

29.

Waikakul S, Sakkarnkosol S, Vanadurongwan V. Vascular injuries in compound fractures of the leg with initially adequate circulation. J Bone Joint Surg Br. 1998;80(2):254–8.CrossRefPubMed

30.

Kuralay E, et al. A quantitative approach to lower extremity vein repair. J Vasc Surg. 2002;36(6):1213–8.CrossRefPubMed

31.

Seligson D, et al. The management of open fractures associated with arterial injury requiring vascular repair. J Trauma. 1994;37(6):938–40.CrossRefPubMed

32.

Guerrero A, et al. Limb loss following lower extremity arterial trauma: what can be done proactively? Injury. 2002;33(9):765–9.CrossRefPubMed

33.

Rerkasem K, Arworn S, Thepmalai K. Prognostic factors of leg amputation in patients with vascular injury: a systematic review. Int J Low Extrem Wounds. 2006;5(2):78–82.CrossRefPubMed

34.

Yeager RA, et al. Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates. Am Surg. 1984;50(3):155–8.PubMed

Title: Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up
Authors: O. Tunali
Y. Saglam
H. I. Balci
A. Kochai
N. A. Sahbaz
O. A. Sayin
O. Yazicioglu
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2017
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-016-0689-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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