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BACKGROUND: Open tibial fractures have a high risk of infection that can lead to severe morbidity. Antibiotics administered locally at the site of the open wound are a potentially effective preventive measure, but there are limited data evaluating aminoglycoside antibiotics. The objective of this study was to assess the feasibility of a clinical trial to test the efficacy of local gentamicin in reducing the risk of fracture-related infection after open tibial fracture. METHODS: This study is a single-center, pilot, masked, randomized controlled trial conducted at the Muhimbili Orthopaedic Institute. Participants were randomized intraoperatively after wound closure to receive gentamicin solution or normal saline solution injected at the fracture site. Follow-ups were completed at 2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 1 year postoperatively. The primary feasibility outcomes were the rate of enrollment and retention. The primary clinical outcome was the occurrence of fracture-related infection. RESULTS: Of 199 patients screened, 100 eligible patients were successfully enrolled and randomized over 9 months (11.1 patients/month). Complete data were recorded at baseline and follow-up for >95% of cases. The rate of follow-up at 6 weeks, 3 months, 6 months, 9 months, and 1 year were 70%, 68%, 69%, 61%, and 80%, respectively. There was no difference in adverse events or any of the measured primary and secondary outcomes. CONCLUSION: This pilot study is among the first to evaluate locally administered gentamicin in open tibial fractures. Results indicate a rigorous clinical trial with acceptable rates of enrollment and follow-up to address this topic is possible in this setting.

Background: Grade III open tibial diaphyseal fractures are challenging to treat and controversy exists on whether to treat them with an intramedullary nail (IMN) or a circular frame (CF). This study aims to compare outcomes for intramedullary nail and circular frame in the treatment of open tibial diaphyseal fractures. Methodology: Retrospective study at a major trauma center of all patients admitted with a grade III open tibial diaphyseal fracture between January 2016 and January 2022. The primary outcome measures were major complications: non-union, malunion, refracture, DBI and amputation. Secondary outcome measures were time to union and reoperation rates. Results: Fifty-five patients were included in the study, 32 patients in CF group and 23 patients in IMN group. There were no significant differences in the baseline demographics of patients in both groups. Major complications were recorded in 13 limbs (54%) in IMN group and in 18 limbs (56%) in CF group which were not statistically significant (p = 0.797). Deep bone infection rates were noted in 4 (12.5%) in the CF group, compared to 1 (4%) in IMN group; however, the result was not statistically significant (p = 0.240). Amputation rates as a result of infected non-unions were seen in 1 limb (4%) in IMN group and 2 limbs (6%) in CF group (p = 0.99). Median time to union was significantly shorter in IMN group at 30 weeks compared to 30 weeks for CF group (p = 0.04). Conclusion: IMN should be the treatment of choice in the treatment of grade III open tibial diaphyseal fracture, but CF should be considered for delayed treatment and in patients with bone loss. [ABSTRACT FROM AUTHOR]

Open tibia fractures frequently occur following high-energy trauma. Contamination of the fracture site combined with limited soft tissue coverage and blood supply means that these open fractures are associated with a high rate of complications, including fracture related infection (FRI). FRI is associated with lowered patient outcomes and requires early recognition and appropriate surgical and medical management. The current evidence on FRI after open tibial fractures largely is limited to case series, small retrospective cohort studies and expert opinion. Recent expert consensus has produced guidelines with the aim of standardising care for these patients. This review summarises the current management strategies employed in treating FRI following open tibial fractures and where possible the evidence behind them. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To Evaluate the AO External Fixator technique outcome in managing open tibia fracture Grade II and IIIA & IIIB. METHODOLOGY: This descriptive cross-sectional study was conducted in the Department of Orthopaedic Surgery, PUMHSW Hospital, Shaheed Benazirabad (Nawabshah), in 2021 after approval. All the patients were selected from Orthopaedics OPD/Emergency Department. The sample size was 101. Data was analyzed using Statistical Package for Social Science (SPSS) software Version 21. Quantitative data were presented with Mean ± SD. Qualitative data were presented in percentages and frequencies. A chi-square test was used to measure categorical variables. RESULTS: Out of 101 patients, 81 were male and 20 were female. The mean age of the patient was 31.05, and SD was 9.511. The Modes of injury: 5 were pedestrian, 3 were bicycle, 61 were a motorcycle, 30 were a car, one fall from height and one from machine injury. The injury site on the right side of the tibia occurred in 56 patients; from the left were 43 patients, and in the bilateral were two. 23.8%, 42.6% and 33.7% of patients had Grade II, IIIA, and IIIB open tibia fractures. 43 (42.6%) patients had simple fractures, 38 (37.6%) patients had wedge fractures, and 20 (19.8%) patients had complex fractures. CONCLUSION: Using an AO External Fixator in open tibia fracture has seen fewer complications in grades II, IIIA, and IIIB. Fracture union was obtained in 90%. Pin tract infection was common and observed in some patients, but antibiotics healed it.

BackgroundOpen tibia fractures are a major source of disability in low- and middle-income countries (LMICs) due to the high incidence of complications, particularly infection and chronic osteomyelitis. One proposed adjunctive measure to reduce infection is prophylactic local antibiotic delivery, which can achieve much higher concentrations at the surgical site than can safely be achieved with systemic administration. Animal studies and retrospective clinical studies support the use of gentamicin for this purpose, but no high-quality clinical trials have been conducted to date in high- or low-income settings.MethodsWe describe a protocol for a pilot study conducted in Dar es Salaam, Tanzania, to assess the feasibility of a single-center masked randomized controlled trial to compare the efficacy of locally applied gentamicin to placebo for the prevention of fracture-related infection in open tibial shaft fractures.DiscussionThe results of this study will inform the design and feasibility of a definitive trial to address the use of local gentamicin in open tibial fractures. If proven effective, local gentamicin would be a low-cost strategy to reduce complications and disability from open tibial fractures that could impact care in both high- and low-income countries.Trial registrationClinicalTrials.gov, Registration # NCT03559400 ; Registered June 18, 2018.

Open fractures of the tibia are one of the most common compound fractures seen in orthopedic practice. These result in severe soft tissue injury and at times associated with vascular injuries which pose a great challenge in management. Gustilo-Anderson's classification is the most commonly used for open fractures of the tibia [type I,II, III (A,B and C)]. Our case includes a 30-yearold male presented with complaints of open injury to the right lower leg post a road traffic accident. Has pain, bleeding, and is unable to bear weight. A 15cm open lacerated wound was seen on the proximal part of the right lower limb. Multiple lacerations were seen on the right foot. It was diagnosed as a Case of Type IIIB compound fracture of the Tibia with periosteal stripping. This case was managed with a repeated debridement, uniplanar unifocal external fixator initially for the first 4 weeks followed by external fixator removal and converting it into tibial nailing. The patient achieved a good functional outcome in terms of full weight bearing and walking after the procedure. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Composite tissue injuries (CTIs) in extremities include segmental bone defects (SBDs) and volumetric muscle loss. The objective of this study was to determine if skeletal muscle autografting with minced muscle grafts (MMGs) could improve healing in an SBD and improve muscle function in a porcine CTI model that includes an SBD and adjacent volumetric muscle loss injury. Adult Yucatan Minipigs were stratified into three groups including specimens with an isolated SBD, an SBD with volumetric muscle loss (CTI), and an SBD with volumetric muscle loss treated with MMG (CTI + MMG). Bone healing was quantified with serial x‐rays and postmortem computed tomography scanning. Muscle function was quantified with a custom in vivo force transducer. Muscle tissue content was determined by biochemical analyses and histology. Anterior cortex‐modified Radiographic Union Score for Tibia fractures (mRUSTs) decreased from 2.7 to 1.9 (p = 0.003) in CTI versus SBD animals. MMG improved anterior mRUST scores to 2.5 in CTI + MMG specimens (p = 0.030 compared to CTI specimens) and overall mRUST scores increased from 9.4 in CTI specimens to 11.1 in CTI + MMG specimens (p = 0.049). Residual strength deficits at euthanasia were 42% in SBD (p < 0.001), 44% in CTI (p < 0.001), and 48% in CTI + MMG (p < 0.001) compared to preoperative values. There were no differences in strength deficits between the three groups. Biochemical and histologic analyses demonstrated scattered differences between the three groups compared to contralateral muscle. MMG improved bone healing. However, the primary cause of muscle dysfunction and biochemical changes was the presence of an SBD. Clinical significance: Early mitigation of SBDs may be necessary to prevent muscle damage and weakness in patients sustaining composite extremity trauma. [ABSTRACT FROM AUTHOR]

Introduction: It was the goal of this study to determine if the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) correlates with complication rates and to determine if it can be used as a predictive tool in the treatment of open tibial shaft fractures. Materials and methods: Retrospective review from two high-volume level 1 trauma centers of open tibial shaft fractures over a 5 year period. Variables of interest included OTA-OFC, type of wound closure, 90-day wound complication, unplanned re-operation, non-union, and amputation. Results: 501 consecutive open tibial shaft fractures. 57.3% (n = 287) were closed primarily; local soft tissue advancement/rotational flap was used in 9.6% (n = 48); free soft tissue transfer used in 22.8% (n = 114); 8.6% (n = 43) required amputation. Of those followed for 90 days (n = 419), 45 (9.0%) had a wound complication, of which 40 (8%) required an unplanned reoperation. 40 (8.0%) patients went on to a documented non-union. All OTA-OFC classification groups significantly correlated with type of definitive closure (r = 0.18–0.81, p < 0.05) with OTA-OFC skin showing the strongest correlation (r = 0.81). OTA-OFC bone loss weakly correlated with wound complication (r = 0.12, p = 0.02) and no OTA-OFC classification correlated with the need for an unplanned secondary procedure. OTA-OFC skin, muscle and arterial all weakly correlated with non-union (r = 0.18–0.25, p < 0.05). OTA-OFC muscle was predictive of non-union (OR = OR = 2.2, 95% CI = 1.2–4.1) and amputation (OR 9.3, 95% CI = 3.7–23.7). OTA-OFC arterial was also predictive of amputation (OR 4.8, 95% CI = 2.5–9.3). Conclusions: The OTA-OFC correlates variably with the type of definitive closure, the development of a 90-day wound complication, and the occurrence of a non-union. Importantly, OTA-OFC muscle classification is predictive of non-union while both OTA-OFC muscle and arterial were predictive of amputation. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Open tibia fractures are a major source of disability in low- and middle-income countries (LMICs) due to the high incidence of complications, particularly infection and chronic osteomyelitis. One proposed adjunctive measure to reduce infection is prophylactic local antibiotic delivery, which can achieve much higher concentrations at the surgical site than can safely be achieved with systemic administration. Animal studies and retrospective clinical studies support the use of gentamicin for this purpose, but no high-quality clinical trials have been conducted to date in high- or low-income settings. Methods We describe a protocol for a pilot study conducted in Dar es Salaam, Tanzania, to assess the feasibility of a single-center masked randomized controlled trial to compare the efficacy of locally applied gentamicin to placebo for the prevention of fracture-related infection in open tibial shaft fractures. Discussion The results of this study will inform the design and feasibility of a definitive trial to address the use of local gentamicin in open tibial fractures. If proven effective, local gentamicin would be a low-cost strategy to reduce complications and disability from open tibial fractures that could impact care in both high- and low-income countries. Trial registration ClinicalTrials.gov, Registration # NCT03559400 ; Registered June 18, 2018.

An open fracture is when the fractured part of a bone is exposed to the external environment by breaching the overlying soft tissue and skin. Open fractures often arise from high-energy injuries, and the risk of microbial contamination is high. There is a need to understand the management of open fractures in Africa by assessing the overall prevalence of open fractures, the mechanisms of injury, management approaches and outcomes. A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding open fracture management in Africa from inception till date. Thirty-nine (39) studies were included in this review. Road traffic accidents represented the majority of all mechanisms of open fractures, with the Tibia being the most affected bone. 320 cases were classified as Gustilo Anderson Type 1, with 487 classified as Type 2. Type 3 was divided into 3A (330), 3B (248), and 3C (34). Most studies recorded the immediate administration of intravenous antibiotics, but tetanus prophylaxis was only given in 13 studies, while initial debridement and washout were done in 35 studies. External fixators and Kirschner wires were most used for initial fixation. Follow-up for patients was between six weeks to 50 months. There were 645 cases of malunion, 83 cases of non-union, and 88 patients who had delayed union. There were 147 cases of wound infection and 119 cases of pin tract infections. Our findings emphasize the need for standardized protocols and robust emergency services to manage open fractures within Africa., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zubair et al.)

Introduction: The induced membrane technique was initially described by Masquelet in 1986 as a treatment for tibia non-union. It then became an established method in the management of bone defects.A critical bone defect is defined by a gap larger than 25 mm, and so, has a higher probability of non-union. Many techniques have been described to resolve this problem such as segmental bone transport, free vascular fibula graft, non-vascular fibula graft, autogenous graft, or megaprothesis., Case Report: We present the case of a 37-year-old woman who presented a multi-fragmentary open fracture of the tibia and fibula bilaterally (Gustilo-Anderson III) after a high-velocity car accident., Conclusion: The aim of this article is to demonstrate that the use of a hybrid procedure combining the Masquelet technique with the Ilizarov external fixator and reamer-irrigator-aspirator can be an effective way to treat bone defect in an open tibial fracture classified as a Gustilo-Anderson III., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. Sources of data We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. Areas of agreement and controversy Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. Growing points It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. Areas timely for developing research A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes. [ABSTRACT FROM AUTHOR]

Purpose: In patients with open tibial fractures, bone and wound infections are associated with an increased hospital length of stay and higher costs. The infection risk increases with the use of implants. Innovations to reduce this risk include antibiotic-coated implants. This study models whether the use of a gentamicin-coated intramedullary tibial nail is cost-effective for trauma centers managing patients with a high risk of infection.Efficacy: Absolute infection risk and relative risk reduction, by fracture grade, for antibiotic-coated nails compared to standard nails for patients with open tibial fractures were estimated based on the results of a meta-analysis, which assessed the additional benefit of locally-administered prophylactic antibiotics in open tibia fractures treated with implants. The observed efficacy of antibiotic-coated nails in reducing infections was applied in an economic model.Methods: The model compared infection rates, inpatient days, theatre usage and costs in high risk patients, with a Gustilo-Anderson (GA) grade III open fracture, for two patient cohorts from a trauma center perspective, with a 1-year time horizon. In one cohort all GAIII patients received a gentamicin-coated nail whilst GAI and GAII patients received a standard nail. All patients in the comparator cohort received a standard nail. Four European trauma centers provided patient-level data (n=193) on inpatient days, procedures and related costs for patients with and without infections.Results: Using the gentamicin-coated nail in patients at high risk of infection (GAIII) was associated with 75% lower rate of infection and cost savings (€477 - €3.263) for all included centers; the higher cost of the implant was offset by savings from fewer infections, inpatient days (-26%) and re-operations (-10%). This result was confirmed by extensive sensitivity analyses.Conclusions: Analyses demonstrated that infection rates and total costs for in-hospital treatment could be potentially reduced by 75% and up to 15% respectively, by using a gentamicin-coated nail in patients at high risk of infection. Fewer infections, reduced inpatient days and re-operations may be potentially associated with use of antibiotic-coated implants. Results are sensitive to the underlying infection risk, with greatest efficacy and cost-savings when the coated implant is used in high risk patients. [ABSTRACT FROM AUTHOR]

Background Management of complex open fractures of the lower extremities needs a special multidisciplinary team in major trauma centers. Limb salvage is attempted in appropriately selected patients via joint orthopedic and plastic surgery care. Recent guidance shows strong evidence of better long-term functional outcomes and decrease of complications when coordinated combined orthoplastic approach can be successfully delivered. Patients and methods A total of 52 patients were included in this retrospective comparative study of the outcomes from two approaches, managed either by single-team approach, plastic or orthopedic (group A), or by orthoplastic setting (group B), in Zagazig University Hospitals between August 2016 and July 2020. All data were collected from the patient records. Follow-up outcomes involved fracture union, weight bearing, persistent deep infection, and secondary amputations. Results The most encountered injury pattern in both groups was Gustilo IIIb. The majority of those injuries were sustained owing to road traffic accidents in both groups. The mean bone loss was 2.05±2.3 cm in group A and 2.06±2.2 cm in group B. There was a statistically significant difference between the mean time to initial debridement, where in group B, it was 8±2.04 h, whereas in group A, it was 10.7±4.2 h (P=0.05). The time to definitive fixation showed a highly significant difference from 9.8±2.9 weeks in group A to 4.4±0.8 weeks in group B. The relative risk for flap loss showed significant reduction in group B (P=0.021). Conclusion Overall outcomes showed obvious improvement with less complication rate of the combined orthoplastic approach over the previous single-team speciality. Nonetheless, certain complications like nonunion and need for secondary amputation did not show quite a significant difference, which may indicate that our early experience with orthoplastic approach for the management of open tibia fracture is in need for further audit and refinements to take place. [ABSTRACT FROM AUTHOR]

Background: Smoking is a known risk factor for complications after open tibia fractures, but it is unclear if smokeless tobacco confers a similar risk., Objective: The purpose of this study was to evaluate the rates of postoperative complications after surgical fixation of open tibia fractures in smokeless tobacco users as compared to matched tobacco naïve controls., Methods: A retrospective cohort study was conducted using the national PearlDiver database. For patients who had a unilateral open tibia fracture, smokeless tobacco users (n=121) and tobacco-naïve controls (n=242) were matched at a 1:2 ratio. Rates of bone complications within 1 year were compared using multivariable logistic regression., Results: Compared to controls, the smokeless tobacco user cohort demonstrated significantly higher rates of nonunion (OR: 3.42, 95% CI: 1.05 - 11.12), infection / inflammatory reaction of implant (OR: 12.45, 95% CI: 2.67 - 58.93), and osteomyelitis of the leg (OR: 6.15, 95% CI: 1.90 - 19.93) within 1 year of open tibia fracture. Compared to the most recent population figures, smokeless tobacco use was significantly under-reported in both males and females., Conclusions: Smokeless tobacco use confers an increased risk of fracture nonunion, infection or inflammatory response to implant, and osteomyelitis of the leg in patients with open tibia fractures. Surgeons should consider this risk when counseling patients and deciding on treatment plans for patients with tibia fractures., Competing Interests: Timothy L. Waters: None Julianna E. Winter: None Bela P. Delvadia: None William F. Sherman: Editorial board member for arthroplasty today, American Academy of Orthopaedic Surgery knee committee member, Paid consultant for Stryker, Associate editor for Orthopedic Reviews Olivia C. Lee: None

Objectives: Open tibia fractures are associated with substantial morbidity and impact on quality of life. Despite increasing incidence in low-resource settings, most open tibia fracture research comes from high-resource settings. This study aimed to assess the impact of socioeconomic status on treatment modality and evaluate predictors of health-related quality of life following open tibia fractures in Ghana., Design: A single-center prospective observational study was conducted in Kumasi, Ghana, from May 2020 to April 2022. Adults with open tibial shaft fractures presenting within 2 weeks of injury were eligible. Demographics, comorbidities, socioeconomic factors, and hospital course were collected at enrollment. Follow-up was scheduled at 8, 12, 26, and 52 weeks. A telephone survey assessing reasons for loss to follow-up was initiated on enrollment completion., Results: A total of 180 patients were enrolled. Most patients were employed before injury (79.9%), had government insurance (67.2%), and were from rural areas (59.4%). Fracture classification was primarily Gustilo-Anderson type 3A (49.1%). No relationship between socioeconomic predictors and treatment modality was identified. The largest barriers to follow-up were preference for bonesetter treatment (63.1%), treatment cost (48.8%), and travel cost (29.8%). Of the lost to follow-up patients contacted, 67 (79.8%) reported receiving traditional bonesetter care. Reasons for seeking traditional bonesetter care included ease of access (83.6%), lower cost (77.6%), and familial influence (50.7%)., Conclusion: No association was identified between socioeconomic predictors and choice of treatment. Bonesetter treatment plays a substantial role in the care of open tibia fractures in Ghana, largely because of ease of access and lower cost., Competing Interests: The authors have no conflict of interest to report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Background: Gustilo type III open tibial fractures are difficult injuries that carry a higher risk of infection and other consequences. Open-fracture wound microbiology is dynamic and responsible for change over time. Effective antibiotic treatment plans are required, as detrimental microorganisms are often linked to these types of lesions., Objectives: The study aimed to determine whether pre- and post-debridement wound cultures could predict wound infection in Gustilo type III open tibial fractures., Methods: This prospective study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, Bangladesh, on 344 patients who presented to the emergency department with a Gustilo type III open tibial fracture within 24 hours of injury from June 2018 to October 2019. Three successive cultures were carried out: one in the emergency room (surveillance culture), the second at the emergency theater after debridement, and the third in the ward after one week (seven to 10 days). Statistical analyses of the results were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY)., Results: The study included 344 patients with an average age of 37.15 years, with motor vehicle accidents being the primary cause (78.2%). Gustilo type IIIA fractures made up the majority (48.5%), followed by type IIIB fractures (44.8%). A significant reduction in contamination rates was observed from initial admission (48.8%) to post-debridement (36.6%) (p =.001). There was a significant positive correlation between pre-debridement cultures and wound infections (r =.311), as well as between post-debridement cultures and wound infections. The infection rate increased to 61.6% in ward samples, indicating a high rate of hospital-acquired infections. Pseudomonas and Klebsiella species were the most prevalent multidrug-resistant bacteria that caused these infections., Conclusion: The present study provides information on the relationship between contamination and infection. Gram-negative pathogens were dominant in this study, and the results of the antibiograms showed an alarming pattern of resistance. Nosocomial infection demands further urgent study., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The institutional review board (IRB) of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) issued approval (NITOR/ACADEMY/2018/1189/A). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Islam et al.)

Background: Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection (SSI). Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI. According to the American College of Surgeons (ACS) Best Practice Guidelines, in 2015, irrigation and debridement should be done within 24 hours., Aim: To identify whether early irrigation and debridement, within 8 hours, vs late, between 8 hours and 24 hours, for pediatric open long bone fractures impacts rate of SSI., Methods: Using retrospective data review from the National Trauma Data Bank, Trauma Quality Improvement Project (TQIP) of 2019. TQIP database is own by the ACS and it is the largest database for trauma quality program in the world. Propensity matching analysis was performed for the study., Results: There were 390 pediatric patients with open long bone fractures who were included in the study. After completing propensity score matching, we had 176 patients in each category, irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours. We found no significant differences between each group for the rate of deep SSI which was 0.6% for patients who received surgical irrigation and debridement within 8 hours and 1.1% for those who received it after 8 hours [adjusted odd ratio (AOR): 0.5, 95%CI: 0.268-30.909, P > 0.99]. For the secondary outcomes studied, in terms of length of hospital stay, patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days, and those who received it after 8 hours stayed for an average of 3 days, with no significant difference found, and there were also no significant differences found between the discharge dispositions of the patients., Conclusion: Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours., Competing Interests: Conflict-of-interest statement: All authors declare no conflict of interest, financial or otherwise., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background:Management of compound tibia fractures remains a challenge for the orthopedic surgeon, not only in adult but also in children. In adult patients, the problems have been studied widely, and numerous published studies on these injuries have focused on the preferred treatment and outcome, and so detailed treatment protocols have been developed, while in children there was no clear guidelines regarding the management of open tibial fractures exist. Aimof this study isevaluate and assess our policy and the protocols for dealing with such type of injuries in children, analyzing the results, the complications and determine the outcome.Methodand results:A cross sectional prospective analytical study including forty six child with the open tibial fractures, were managed and treated between September 2013 and October 2020 in Al-Husain teaching hospital of Nasiriya city-Iraq. The average duration of follow up was (10) months, range (3-36) months. Gustilo–Anderson classification is used to recorded the different grading and severityof fractures toType I 15 patients (32.60%) ; Type II 20 patients (43.47%) ; Type IIIA 7 patients (15.21%) ; Type IIIB 4 patients (8.69%).Conclusion:Age, gender,mechanism of injury were not independent factors for the determination of the complication, delayed union and non-union mainly affected by Gustilo et al. class of fracture grading, where the percentages increase with the grading advancement.The outcomes not differ from that of the adult tibial fracture. Type of method of fracture fixation not demonstrating the outcome [ABSTRACT FROM AUTHOR]

Purpose: Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail.Methods: The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemoglobin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant.Results: There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X2 = 4.66, p = 0.031). At 6 months postoperatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant difference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016).Conclusion: Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate and compare the surgical site infection (SSI) rates of children and adults after open tibia fracture at a single medical centre.Methods: A retrospective study was performed on patients who sustained open tibia fractures and who received treatment at our hospital from 2012 to 2016. Data on age, gender, fracture site, Gustilo-Anderson grade, treatment management, and culture results from the infection site were recorded.Results: Overall, 37 children with a mean age of 7.19 ± 2.28 years and 89 adults with a mean age of 40.38 ± 13.53 years were enrolled. The rate of SSIs was 13.5% (6/37) in children, which was significantly lower than the 21.3% (19/89) rate in adults (p < 0.001). The mean number of days to discharge was 12.86 ± 10.25 in children, which was significantly lower than the mean of 28.67 ± 16.92 days in adults (p < 0.001). Furthermore, the average waiting time for soft tissue recovery before definitive surgery was 1.41 ± 1.79 and 8.42 ± 4.38 days in children and in adults, respectively, and the difference was significant (p < 0.001). Early infection occurred more frequently in adults (5/19) than in children (0/6). Staphylococcus aureus was the most commonly found pathogen in both groups.Conclusion: The SSI rate of paediatric patients after open tibia fracture fixation is significantly lower than that of adults, and the prognosis of the former is superior. The results indicate a superior ability of soft tissue recovery and infection resistance after open tibia fracture fixation among children. [ABSTRACT FROM AUTHOR]

Background Treatment algorithms for large soft tissue defects in lower extremity trauma are not clearly defined. The aim of this study is to determine if there are geographic or demographic differences in themanagement of open tibia fractures with soft tissue defects requiring either soft tissue reconstruction or amputation in the United States (US). Methods A retrospective analysis was performed on the Nationwide Inpatient Sample (NIS), 2000 to 2011.We evaluated flap and amputation rates in the open tibia fractures with soft tissue defects based on geographic and socioeconomic factors. Results From 2000 to 2011, there were 175,283 open tibia fractures in the US; 7.2% (n = 12,620) had a concomitant soft tissue defect requiring either flap or amputation. The overall flap rate was 73.2% (n = 9,235). When compared with the South at 68%, flap rates were highest in the West at 79% (adjusted odds ratio [AOR] = 2.06; 95% confidence interval [CI] = 1.49, 2.86; p < 0.0001), followed by the Northeast at 77% (AOR = 1.63; 95% CI = 1.22, 2.19; p = 0.001), and the Midwest at 74% (AOR = 1.76; 95% CI = 1.25, 2.47; p = 0.001). Flap rates were lower in the rural hospitals in theWest (AOR = 0.24; 95% CI = 0.07, 0.84; p = 0.03) and Northeast (AOR = 0.55; 95% CI = 0.37, 0.82; p = 0.003) when compared with the urban hospitals. Flap rates were highest in the highest income quartile at 77% (AOR = 1.53; 95% CI = 1.05, 2.25; p = 0.03) compared with 72% in the lowest income quartile. Conclusions Reconstruction rates were significantly higher in three major US regions when compared with the South, urban hospitals in the West and Northeast, and the highest income quartile. [ABSTRACT FROM AUTHOR]

Objective: To evaluate functional and radiological results following treatment with the single-plane external fixator limb reconstruction system (LRS) for open tibial diaphyseal fractures resulting from high-energy trauma.Subjects and Methods: From a total of 62 patients who were operated on between 2011 and 2014 for open tibial diaphyseal fractures resulting from high-energy trauma, 50 tibias from 49 patients (males: 32, females: 17) were classified as type 3 according to the Gustilo-Anderson open fracture classification, and definitive treatment was applied with the LRS. The patients ranged in age from 20 to 36 years. Time to union, time of external fixator usage, complications and functional results according to the Johner-Wruhs criteria were recorded.Results: The mean follow-up period was 23 ± 12 months (range: 11-44). Of the 50 tibias, full union was achieved with the LRS in 48 (96%). No shortness or deformity was observed in any patient. Knee and ankle range of movement were measured as full in all patients at the final follow-up examination after removal of the LRS. The mean time to union was 20.4 ± 4 weeks (range: 16-24). The mean time of external fixator use was 20 weeks (range: 16-24 weeks).Conclusion: In this study, for the definitive treatment of open tibia diaphyseal fractures, the LRS was an optimal and safe choice that offered single-stage surgery. [ABSTRACT FROM AUTHOR]

Background: Open fractures of the tibia are complex injuries of bone and soft tissue. And on account of the open nature has a tendency to increase morbidity. The main objectives of this study was to determine peculiar issues in the management of open tibia fractures with regards to the pattern, aetiology and management outcome of treatment of open tibia fractures. Outcome measures included functional outcome, complications, morbidity and case fatality in our environment Lagos; Nigeria. Methods: This prospective study was carried out at Lagos University Teaching Hospital (LUTH), Lagos Nigeria between July 2011 and June 2014. Demographic data, fracture related characteristics, aetiology, location radiologic features and microbiological cultures were collected. Diagnosis of open tibia fracture was based on clinical and radiological evaluation. Infection was diagnosed on the basis of a combination of clinical evidence\microbiological evidence (culture). All cases were followed up till discharge or death and subsequently in our out-patient clinic after discharge for 12months. Complications arising in the course of case management as well as functional outcome were documented. Results: A total of 197 patients with open tibia fracture out of 6071 patients presenting to the accident and emergency department over 3 years period were reviewed. Open tibia fracture represented 3.24% of all presentation. 145 (73.6%) were male, while 52 (26.4%) were female with average age range from 1-90 years (mean 36.9±18.9years). The peak age of incidence was in the age bracket 21- 50years. Vehicular accident accounted for 78.2%, whereas other forms of injury accounted for 21.8%. The pattern of fracture was oblique 93 (47.2%), Transverse fracture 63(32%). while comminuted, segmental and spiral were 22(11.2%), 11 (5.6%) and 8 (4.1%) respectively the most common lesion was type II (49.2%) injury. The complication rate was 68 (34.5%) patients with wound infection accounted for 44(22.3%). Other complication observed included malunion 6.6%; non- union 3%, four patients (2%) had amputation. Both of whom had Gustilo Anderson type III c Injuries with mangled extremities severity score greater than seven. The functional outcome was quite satisfactory. Conclusion: This study has shown that open fracture pose some unique risks beyond those encountered with similar closed fractures that may occur with similar amount of force and that wound infection is the commonest complications. It also shows that morbidity is associated with injury severity. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the clinical results after operative treatment of open tibia fractures (grade IIIA/B) with external fixator. Material and methods: 25 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated in Agency Headquarter Hospital Landikotal. All the patients were treated with an external fixator. The time of the union of the fracture, problems with the union (malunion and nonunion), infection were examined as treatment outcome. Late complications and their treatment was not the object of the study. The follow-up period was at least 8 months. Result: The end results of the external fixation of 25 tibial shaft fractures, 18 (72%) men and 7 (28%) women, average age 37.7 (16-65). The union rate was 83%. Nonunion rate was 12%. And malunion rate was 5% (fig-I). Fifteen patients had Gustilo type IIIA injury while 10 patients had type IIIB injury (fig-II). Pins tract infection rate was 10%. The average time of fractures healing was 28.5 weeks (15-22). There were 3 cases with wound infection and no sequestrum formation. Conclusions: External fixation is a simple and effective means of treating all types of open tibial shaft fractures. [ABSTRACT FROM AUTHOR]

Background: Lower extremity salvage in the setting of severe trauma requires the consideration of multiple surgical specialties and treatment algorithms. We hypothesized that time to first ambulation, ambulation without an assistive device, chronic osteomyelitis, and delayed amputation were not affected by the time to soft tissue coverage in Gustilo IIIB and IIIC fractures at our institution., Methods: We evaluated all patients treated for open tibia fractures at our institution from 2007 to 2017. Patients requiring any form of soft tissue coverage to the lower extremity during their initial hospitalization and who had at least 30 days of follow-up from time of hospital discharge were included. Univariable and multivariable analysis was performed for all variables and outcomes of interest., Results: Of 575 patients included, 89 required soft tissue coverage. On multivariable analysis, the time to soft tissue coverage, length of negative pressure wound therapy treatment, and number of wound washouts were not found to be associated with development of chronic osteomyelitis, decreased 90-day return to any ambulation, decreased 180-day return to ambulation without assistive device, or delayed amputation., Conclusions: Time to soft tissue coverage in open tibia fractures did not affect time to first ambulation, ambulation without an assistive device, chronic osteomyelitis, or delayed amputation in this cohort. It remains difficult to definitively prove that time to soft tissue coverage meaningfully impacts lower extremity outcomes., Competing Interests: Disclosures: The authors disclosed no conflicts of interest., (© 2022, HMP Global. All rights reserved. Reproduction in whole or in part prohibited. Content may not be reproduced in any form without written permission. Rights, Permission, Reprint, and Translation information is available at www.hmpglobal.com.)

Introduction: Fractures of the lower extremity are a common type of childhood injury and many can be treated without surgery. Dislocated and open fractures are an indication for fracture stabilization via either intramedullary nailing or, in the case of complicated fractures, external fixation. But if complications are likely because of diseases and disabilities (for example, a neuropathy) that can complicate the post-operative procedure and rehabilitation, what options does one have?Case Presentation: We report a nine-year-old Caucasian girl who had hereditary motor and sensory neuropathy type I and who was admitted with a grade I open tibia fracture after a fall from a small height. Plain radiographs showed a dislocated tibia and fibula fracture. An open reduction with internal fixation with a compression plate osteosynthesis was performed, and soft tissue debridement combined with an external fixateur was undertaken. Three months later, she was re-admitted with localized swelling and signs of a local soft tissue infection in the middle of her tibia. Plain radiographs showed a non-union of the tibia fracture, and microbiological analysis confirmed a wound infection with cefuroxime-sensitive Staphylococcus aureus. Because of the non-union, the osteosynthesis was replaced with an Ilizarov external fixateur, and appropriate antibiotic therapy was initiated. Four months after the initial accident, the fracture was consolidated and we removed the external fixateur.Conclusions: If there is a pre-existing neuropathy and if disease makes it difficult for a child to follow all post-operative instructions, salvage procedures should be kept in mind in case of complications. There are multiple therapeutic options, including osteosynthesis, intramedullary nailing systems, cast therapy, or an external fixateur like the Ilizarov or Taylor spatial frame system. The initial use of an external fixateur such as an Ilizarov or Taylor spatial frame in patients with pre-existing neuropathies should be kept in mind as a possible treatment option in complicated fractures, especially in a child with pre-existing neurological or endocrine pathologies. [ABSTRACT FROM AUTHOR]

External fixators are the most common fixation method for fractures with substantial soft tissue compromise. Nonetheless, the frames used are bulky, uncomfortable, and cumbersome to patients. Using locking compression plate (LCP) as an external fixator (low profile external fixation/LPEF) owns the same properties as standard external fixators but may overcome disadvantages because of its low-profile frame. This case series aims to evaluate the results of LPEF for the management of tibia fracture with soft tissue compromise. We reviewed five patients at our centers who underwent surgery in 2020 with the application of LPEF. These patients had grade IIIA open tibia fracture with respective complications. The follow-up duration was 6 months post-operative in which we assessed Southampton Wound Assessment Scale (SWAS), laboratory infection markers, radiographic evaluation, and the Lower Extremity Functional Scale (LEFS). The results showed all wounds healed and cases with infection showed tendency of resolving, alongside varying degree of bone healing. The implant was well tolerated for patients and the functional outcome was overall good (mean LEFS: 71.26%). The LPEF is fortuitously lightweight and more convenient for patients to ambulate, thus the compliance of early functional exercise is more likely to happen. Application of LPEF can be considered as an option for treating soft tissue compromised tibia fracture. In our experience, it is low profile, more acceptable to the patients, and displayed favorable outcomes especially in terms of soft tissue or skin healing and infection resolution. • Low profile external fixation can be an alternative to external fixation. • Cases displayed favorable outcome in regards to wound healing and infection resolve. • The compliance of early functional exercise is more likely to happen. • An attractive treatment option for soft tissue compromised tibial fracture. [ABSTRACT FROM AUTHOR]

Open tibial fractures are challenging injuries to deal with. To receive the best outcome they require the services of both an experienced orthopaedic trauma surgeon and plastic surgeon with an interest in lower limb trauma. The A&E management should follow ATLS protocols followed by administration of prophylactic antibiotics. The surgical management includes adequate débridement, lavage, skeletal stabilisation and ultimately soft tissue coverage. The best method of skeletal stabilisation is yet to be proven, although from the studies available it appears that reamed and unreamed nailing as well as external fixation are all acceptable surgical options, each with their own advantages and disadvantages, which the surgeon should be aware of. The results of immediate soft tissue coverage following open tibia fractures are encouraging, however this method is not yet adequately proven to be safe by randomised controlled trials, and hence cannot be encouraged routinely. Definitive soft tissue cover should certainly be achieved within 5–10 days of the injury. Bone morphogenic proteins may have a role in promoting union of grade III open tibial fractures. When patients have a mangled extremity score of greater than or equal to 7, or grade IIIC injuries, surgeons should consider early amputation, rather than limb salvage. [ABSTRACT FROM AUTHOR]