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European Journal of Orthopaedic Surgery & Traumatology

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01-05-2020 | Proximal Tibia Fractures | Original Article

Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures

Authors: Gianluca Canton, Federico Santolini, Marco Stella, Antonio Moretti, Michele Francesco Surace, Luigi Murena

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 4/2020

Abstract

Background

Soft tissues (wound dehiscence, skin necrosis) and septic (wound infection, osteomyelitis) complications have been historically recognized as the most frequent complications in surgical treatment of high-energy proximal tibia fractures (PTFs). Staged management with a temporary external fixator is a commonly accepted strategy to prevent these complications. Nonetheless, there is a lack of evidence about when and how definitive external or internal definitive fixation should be chosen, and which variables are more relevant in determining soft tissues and septic complications risk. The aim of the present study is to retrospectively evaluate at midterm follow-up the results of a staged management protocol applied in a single trauma center for selective PTFs.

Methods

The study population included 24 cases of high-energy PTFs treated with spanning external fixation followed by delayed internal fixation. Severity of soft tissues damage and fracture type, timing of definitive treatment, clinical (ROM, knee stability, WOMAC and IOWA scores) and radiographic results as well as complications were recorded.

Results and conclusion

Complex fracture patterns were prevalent (AO C3 58.3%, Schatzker V–VI 79.1%), with severe soft tissues damage in 50% of cases. Mean time to definitive internal fixation was 6 days, with double-plate fixation mostly chosen. Clinical results were highly satisfying, with mean WOMAC and IOWA scores as 21.3 and 82.5, respectively. Soft tissue complication incidence was very low, with a single case of wound superficial infection (4.3%) and no cases (0%) of deep infection, skin necrosis or osteomyelitis. Staged management of high-energy PTFs leads to satisfying clinical and radiographic results with few complications in selected patients.

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Title: Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures
Authors: Gianluca Canton
Federico Santolini
Marco Stella
Antonio Moretti
Michele Francesco Surace
Luigi Murena
Publication date: 01-05-2020
Publisher: Springer Paris
Keyword: Proximal Tibia Fractures
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 4/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02619-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures

Abstract

Background

Methods

Results and conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results and conclusion

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