Primary free-flap cover of open tibial fractures

Eosinophils are important cells of inflammatory infiltration in respiratory tract of asthmatics patients. Rantes is a potent chemotactic agent for eosinophils. It belongs to the chemokine family. Heparin has been reported to diminish size of allergen skin tests and decrease response to allergen bronchoprovocation in allergic asthma. We have found that heparin diminished late phase of allergic reaction and inhibits allergen induced increase in specific and nonspecific bronchial hyperresponsiveness. In order to explore the mechanism involved in these protective effects we studied the influence of heparin on eosinophil chemotaxis induced by Rantes and FMLP. Eosinophils were isolated from peripheral blood of 12 asthmatic donors. Chemotaxis was evaluated using polycarbonate filters in 48-well chemotactic chamber. The table shows the results (*) p < 0.05. [table: see text] Ten minutes exposure of eosinophils to heparin was sufficient for inhibition. Removal to heparin by washing the cells ablated observed effects. Preincubation of Rantes or FMLP with heparin did not induce any significant changes in eosinophil chemotaxis. Heparin alone did not posess any chemotactic activity for eosinophils. Our results suggest that heparin ameliorate allergic inflammation by inhibition of eosinophil flux and this inhibition is a surface phenomenon.     

Advantages of the unreamed tibial nail in comparison with external fixator in treatment of grade 3 B open tibial shaft fractures

Between 1987 and 1993, 41 grade 3B open tibial shaft fractures were treated with the unreamed tibial nail (URTN n = 22) or an external fixator (FIX n = 19). The method of treatment was left to the choice of the operating surgeon. Three below the knee amputations were performed, three patients died, and three were lost to follow-up. In all, 32 patients were followed up to union or at least for 1 year. There were no significant statistical differences between the two groups (P < 0.2, chi-squared, t-test) with respect to fracture type, fracture location, age, gender or accompanying injuries. The URTN group showed significantly better results regarding time to full weight-bearing (URTN 11 +/- 4 weeks; FIX 20 +/- 11 weeks, P < 0.01 M-W) Mann-Whitney Test, number of reoperations (URTN 1.04; FIX 2.89; P < 0.01 M-W), isolated bone grafting (URTN 3/22; FIX 8/19; P < 0.05 chi-squared), and average Karlstr?m and Olerud score (URTN 30 +/- 4; FIX 26 +/- 5; P < 0.05 M-W). In all, 15/17 URTN patients and only 6/15 FIX patients achieved unlimited walking distance (P < 0.01 M-W). Time to bony union, infection, and nonunion were not significantly different between groups.     

Reemployment of patients with surgical salvage of open, high-energy tibial fractures: an outcome study

The association of soft tissue and bone sarcoidosis in the hand and wrist is rare. Two cases of sarcoidosis, 1 with involvement of the distal radius and both flexor and extensor tendons in the wrist and another with tenosynovitis of 2 fingers associated with phalangeal osteolysis, are reported. Both patients were surgically treated by tenosynovectomy. The importance of the systemic corticosteroid therapy is emphasized.     

Nonreamed flexible locked intramedullary nailing in tibial open fractures

Thirty-nine open unstable tibial shaft fractures were treated with a nonreamed flexible locked intramedullary nail between 1992 and 1995. There were 23 Grade I, 12 Grade II, three Grade IIIA, and one Grade IIIB fractures. The average time of followup assessment was 24 months. The average time to fracture union was 24 weeks. Complications were related in most cases to fractures with highly unstable patterns and extensive soft tissue lesions. There were five (12.5%) delayed unions and one (2.5%) nonunion. Deep infections developed in three (7.7%) patients. One patient required an additional procedure to correct a varus malunion. There were no implant failures. It was concluded that nonreamed flexible locked nailing provides effective control of axial and rotational stability in unstable Grades I to IIIA open fractures with acceptable union rates and a low incidence of complications secondary to the fixation system.     

Clinical results of primary intramedullary osteosynthesis with the unreamed AO/ASIF tibial intramedullary nail of open tibial shaft fractures

From 04/91 to 06/96 sixty-nine open fractures of the tibia were primarily treated on the day of the accident with unreamed nailing (UTN, Synthese). The distributions of fracture type according to the AO classification and of soft tissue injury according to Gustilo were as follows: fracture type: A: 28%, B: 52%, C: 20%; soft tissue injury: I: 30%, II: 28%, IIIA: 12%, IIIB: 12%, IIIC: 6%. Of the 65 fractures assessed 46 (71%) healed within 18 weeks without secondary intervention. There was delayed healing in three fractures requiring secondary conversion to reamed nailing. Eight fractures (12%) developed pseudarthrosis of which five (8%) healed uneventfully. Deep infections was manifest in four fractures (6%). Three of these infections developed after secondary intervention to treat pseudarthrosis. Seven of the eight pseudarthroses and three of the four infections healed eventually. Revision procedures were necessary in 11 patients (17%) to deal with disturbed fracture healing or infection (10 reamed nailing procedures, three cancellous bone grafts, and one of each of the following: sequestrectomy, fibular osteotomy, plate fixation, external fixator, monorail procedure). The results show that the same good infection rates were achieved for the UTN as for the external fixator. The advantages of the UTN are, however, a lesser need for secondary intervention and greater patient comfort. Therefore, we find the UTN to be a good alternative to the external fixator in the treatment of open fractures with severe soft tissue damage.     

Indications for surgical treatment of tibial condyle fractures

The residual radioanatomic changes influencing the functional, subjective, and clinical outcome of 131 tibial condyle fractures were studied. Clinical function was found to deteriorate rapidly with increasing values of residual medial tilt of the tibial plateau, whereas lateral tilt of the plateau was well tolerated up to 5 degrees. Articular step-off up to 3 mm and condylar widening up to 5 mm had no adverse effects. Seventy percent of knees with moderate or severe instability were functionally unacceptable. It was concluded that a medial unicondylar fracture with any displacement, and all medially tilted bicondylar fractures, should be operated upon. In fracture of the lateral condyle, open reduction and internal fixation is indicated when lateral tilt or valgus malalignment exceeds 5 degrees, articular step-off exceeds 3 mm, or condylar widening exceeds 5 mm. The same limits apply to laterally tilted bicondylar fractures, provided that the medial condyle is undisplaced. Any displacement seen in the axial bicondylar fracture is an indication for surgical treatment. If there is any mediolateral instability in the extended knee joint after rigid internal fixation, repair of a collateral ligament should be considered. An avulsed anterior cruciate ligament should be fixed, if pathologic laxity exists, but the torn ligament can be ignored and reconstructed later if needed.     

Surgical treatment of malleolar fractures. A review of 144 patients

Malleolar fractures are one of the most common fractures faced in orthopaedic surgery. The results from a consecutive series of 144 malleolar fractures during a 10-year period that were classified and treated according to the AO system are presented. Assessment of outcome was done using the scoring system of Baird and Jackson, which is based on subjective, objective, and radiographic criteria. Excellent and good results were achieved in 107 of the 144 patients surgically treated. Overall, excellent and good results were obtained in almost all unimalleolar fractures, but were significantly less in bimalleolar fractures. There was no difference in outcome achieved between Weber C and Weber D fractures. The presence of a large bony fragment or dislocation also significantly affected the final outcome. Posttraumatic osteoarthritis was found to be associated significantly with poor clinical results, bimalleolar fractures, and unsatisfactory surgical reduction.     

Management of IIIB open tibial fractures by early osteosynthesis and local muscle flap

From 1986 to 1994 18 patients with 19 IIIB open tibial fractures were treated following similar therapeutic management. This included early and radical primary debridement, early and wherever possible immediate internal fixation of the bone and coverage with a local muscle flap (hemisoleus or gastrocnemius). At the time of follow-up all fractures had consolidated clinically as well as radiographically. The mean time to bony union was 7 months (3-20). Twelve patients did not have any severe pain and were able to walk for more than 4 km. The time to return to work averaged 8 months. In 2 cases a permanent disability of 50% was established. Fourteen of 18 patients were satisfied with the function of the leg. On the other hand, 9 didn't like the aesthetic appearance and were inhibited because of it. The following complications occurred within a period of 2 years: non-union (3), flap necrosis (2), osteomyelitis (2), delayed union (4). The mean number of reoperations was 3 (0-8). In no case did an amputation have to be performed.     

Management of patients with pyogenic complications of long bones open fractures

122 patients with purulent complications of open diaphyseal fractures of long bones were treated. Comparative analysis of different surgical methods for treatment of pyogenic complications has shown that the most effective method is one of active sanation of the area of inflammation with the use of combined drainage ensured successful and steady decrease of pyogenic process (follow-up up to 4 years, 89.7% of patients). The drainage provides stable fixation of bones fragments by dipped fixators until consolidation of the fracture. It also promotes repain of residual diaphyseal defects without application of complicated plastic methods.     

Treatment of open tibial fracture with Ender nail

This study was designed to examine the burnout symptoms among nurses in different settings, differing by specialty, age, gender, number of years on the job, and place of work, in the People's Republic of China. A total of 1,100 nurses completed the Maslach Burnout Inventory. Burnout symptoms in nurses were related to setting, specialty, age, gender, place of work, and number of years on the job. The findings suggest that the physical features in clinics and in obstetrics and gynecology departments should be improved and that social and public health support systems, as well as stress management skills, should be offered to new nurses in order to improve their ability to cope with stress and to improve the quality of care for patients.     

The role of fixation of the fibula in open fractures of the tibial shaft with fractures of the ipsilateral fibula: indications and outcomes

To determine the indications for fibular fixation in cases of combined fractures of the tibia and fibula and the effect of fibular fixation on tibial healing, a retrospective study of open fractures of the tibial shaft with concomitant fibula fractures was conducted at a level one trauma center. Apparent indications for fibular fixation included the presence of a syndesmotic injury and location of fracture within the distal third of the fibula. No significant differences were found in the healing rates, incidence of nonunion and malalignment, or in the number of required subsequent procedures between patients who did and did not undergo fibular stabilization. These results suggest that fixation of the fibula in open fractures of the tibia and fibula has no effect on fracture healing or alignment. A randomized, prospective study is needed to properly validate these findings.     

Surgical treatment of trochanteric fractures of the femur]

The authors present the results of studies of etiology of acute group intestinal diseases in neonates from whom escherichia of serological group 0128ac:K67 possessing the following characteristics were isolated: of the same (with the H12 antigen) serological and enzymatic type (nonfermenting sucrose and raffinose, fermenting dulcit and sorbit the first 24 hours, and slowly fermenting ramnose). All the cultures isolated were resistant to the majority of antibiotics used at present, and were only weakly sensitive to erythromycin. Difficulties (agglutination of live cultures with production sera in the absence of low agglutinability of heated cultures) in serological typing of the cultures were due to different partial O-antigen composition of the cultures isolated and of the production strain used in the preparation of commercial sera of the given serological group (0128ab:K67). Because circulation of escherichia of serological 0128ac variant was revealed in the USSR there occurred a necessity of their identification in practical laboratories; for this purpose organization of industrial production of the corresponding serum is necessary.     

Peroneal osteocutaneous flap raised on reconstructed popliteal artery for delayed union following open tibial fractures

Cardiac function was assessed in long-term survivors of malignant bone tumors who were treated according to Rosen's T5 or T10 protocol, both including doxorubicin. Thirty-one patients, age 10-45 years (median age 17.8 years) were evaluated 2.3-14.1 years (median 8.9 years) following completion of treatment. Cumulative doses of doxorubicin were 225-550 mg/m2 (median dose 360). The evaluation consisted of a history, physical examination, electrocardiogram (ECG), signal averaged ECG, 24-hour ambulatory ECG, echocardiography and radionuclide angiography. Eighteen of 31 (58%) patients showed cardiac toxicity, defined as having one or more of the following abnormalities: late potentials, complex ventricular arrhythmias, left ventricular dilation, decreased shortening fraction, or decreased ejection fraction. The incidence of cardiac abnormalities increased with length of follow-up (P< or = .05). No correlation could be demonstrated between cumulative dose of doxorubicin and cardiac status, except for heart rate variability. When adjusted to body surface area, the left ventricular posterior wall thickness (LVPW index) was decreased in all patients. The incidence of doxorubicin-induced cardiotoxicity is high and increases with follow-up, irrespective of cumulative dose. Life-long cardiac follow-up in these patients is warranted. The results of our study suggest that heart rate variability and LVPW index could be sensitive indicators for cardiotoxicity.     

Interlocked intramedullary nailing for treatment of open femoral shaft fractures

Twenty-eight patients with open femoral shaft fractures treated by reamed intramedullary nailing were reviewed retrospectively. Nine patients had Gustilo Grade I injuries; 14, Grade II; and five, Grade IIIA. Twenty cases had static locking, two cases had dynamic locking, and six cases were not locked. Average time to union was 20 weeks. The infection and nonunion rates were 0%. The data suggest that interlocked reamed intramedullary nailing is a safe treatment option for treating open femoral shaft fractures.