Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and Treatment Algorithm.
Background: The management of traumatic composite bone and soft tissue loss (TCBSTL) requires a classification system and decision-making algorithm for the purpose of description, prognosis and choice of treatment method.Patients and Methods: between the year 2000 and 2017 a series of 254 cases of T...
| Publicado en: | Injury Vol. 51; no. 6; pp. 1352 - 1362 |
|---|---|
| Autores principales: | , |
| Formato: | Journal Article |
| Publicado: |
Elsevier B.V.
Jun2020
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143742686&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 143742686 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201383 JGC jtl: Injury issn: 00201383 maglogo: N pubinfo: dt: Jun2020 vid: 51 iid: 6 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 143742686 143742686 NLM32327233 10.1016/j.injury.2020.03.041 NLM32327233 143742686 ppf: 1352 ppct: 10 formats: tig: atl: Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and Treatment Algorithm. aug: au: El-Rosasy, Mahmoud A. Ayoub, Mostafa A. affil: Department of Orthopaedic Surgery & Traumatology, Tanta University, Faculty of Medicine, Tanta, Egypt sug: subj: Soft Tissue Injuries Surgery Fractures, Open Surgery Bone Lengthening Tibial Fractures Surgery External Fixators Postoperative Complications Physiopathology Adolescence Treatment Outcomes Radiography Debridement Fractures, Open Complications Leg Length Inequality Surgery Female Tibial Fractures Complications Middle Age Adult Fracture Healing Physiology Young Adult Ilium Transplantation Fractures, Open Skin Transplantation Fracture Fixation Recovery Aged Child Fracture Fixation Methods Soft Tissue Injuries Diagnosis Trauma Severity Indices Retrospective Design Male Soft Tissue Injuries Complications Algorithms Tibial Fractures Scales Adolescent: 13-18 years Middle Aged: 45-64 years Adult: 19-44 years Aged: 65+ years Child: 6-12 years Female Male ab: Background: The management of traumatic composite bone and soft tissue loss (TCBSTL) requires a classification system and decision-making algorithm for the purpose of description, prognosis and choice of treatment method.Patients and Methods: between the year 2000 and 2017 a series of 254 cases of TCBSTL were treated using distraction histogenesis and external fixation techniques. The tissue loss was due to either the initial injury or debridement of infection. Adjunctive procedures included split thickness skin grafting and ICBG when indicated. A classification system was designed by the author. The classification is based on factors that influence management and prognosis; (1) stability of the host bone (intact tibia or a well-fixed fracture), (2) presence or absence of infection in the fracture site, (3) size of bone defect, and (4) contamination (infection) of the medullary cavity. A flowchart and decision-making algorithm was subsequently developed.Results: Ilizarov external fixator was used in all cases. Ten cases (4%) had combined Masquelet - Ilizarov technique. One hundred seventy five cases (68.9%) had gradual distraction-compression (GDC) technique; while 79 cases (31.1%) had acute shortening and re-lengthening (ASRL) technique. Seventy-two cases (28.3%) had autogenous iliac crest bone graft (ICBG). All cases (100%) had complete clinical and radiological fracture union. All patients completed the follow up that ranged from 24 to 118 months (mean 43.3 ± 23). The results were satisfactory in 212 cases (83.5%) and unsatisfactory in 42 (16.5%) cases due to residual leg length discrepancy, joint stiffness, and persistent pain.Discussion: the proposed classification is simple, applicable, recallable and includes most scenarios of reconstructable TCBSTL. The classification provides a basis for communication, description and evaluation of such cases. The algorithm, based on our classification, provides a guideline for management without over/under treatment. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|