Title: Application of damage control orthopaedics in the management of type III open tibia fractures in a hilly region of North India
Authors: Tanveer Ahmed Bhat, Imtiyaz Ahmad Beigh, Sayar Ahmad Mantoo, Malik Naseer Ahmad, Zubair Ahmad Lone, Tanveer Ali, Karanbir Singh
DOI: https://dx.doi.org/10.18535/jmscr/v7i10.36
Abstract
Introduction: This study was conducted to analyse the outcomes of type III open tibia fractures arising out of high energy motor vehicle accidents in the hilly areas of Jammu province managed by applying the principles of damage control orthopaedics.
Methods: A retrospective study was carried out in seventeen patients with type III open tibia fractures. These patients were selected among the 243 cases that were injured in five major MVAs in the hilly areas of Jammu province between 2016 and 2019. External fixators were used for stabilisation of fractures in all patients on the first day of admission in Govt. Medical College and Hospital, Jammu according to principles of damage control orthopaedics.
Results: Bone union was achieved in fourteen patients. One patient needed amputation on the fifth post-op day. The mean time for bone union was 2.9 months (2 to 3.5 months) in case of conversion to internal fixation, and 6.5 months (2 to 15 months) when external fixation was extended and used as definitive method of fixation. No infectious complications were observed in the cases which underwent early conversion definitive fixation. After a mean follow-up of 24 months (7 to 30 months) fourteen patients recovered functionally and thirteen could return to duty with one patient still recovering from sciatic nerve injury.
Conclusion: This study highlights the utility of temporary external fixation as a damage control treatment modality in both preventing a second- hit phenomenon and enhancing bone healing and functional recovery in type III open tibia fractures.
Keywords: Damage control orthopaedics; External fixator; Tibia fracture; Motor Vehicle Accident; Open fracture.
References
- https://www.aaos.org/search.aspx?id=32&srchtext=Christina+L.+Boulton%2c+MD
- Anil kumarjoshi, chitrajoshi , mridusingh, et al. Road traffic accidents in hilly regions of northern india: what has to be done?World journal of emergency medicine 5(2, 112, 2014)
- Mathieua, F. Bazilea, R. Barthélémya, P. Duhamelb, et al. Damage control orthopaedics in the context of battlefield injuries: The use of temporary external fixation on combat trauma soldiers Orthopaedics & Traumatology: Surgery & Research (2011) 97, 852—859
- Beltsios, M., Savvidou, O., Kovanis, J. et al. External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strat Traum Limb Recon (2009) 4: 81. https://doi.org/10.1007/s11751-009-0062-3
- Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM.Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients. The Journal of Bone and Joint Surgery 82(6):781-8
- Malik ZU, Hanif MS, Safdar A, Masood T. Planned external fixation to locked intramedullary nailing conversion for open fractures of shaft of femur and tibia.J Coll Physicians Surg Pak. 2005 Mar;15(3):133-6.
- Yoshiyasu Uchiyama, Yuka Kobayashi, Gro Ebihara, Kosuke Hamahashi, Masahiko Watanabe. Retrospective comparison of postoperative infection and bone union between late and immediate intramedullary nailing of Gustilo grades I, II, and IIIA open tibial shaft fractures. Trauma Surg Acute Care Open 2016;1:1–4. doi:10.1136/tsaco-2016-00003
- Nicoll EA. Closed and open management of tibial fractures. Clin Orthop Relat Res 1974:144–53. [PubMed] [Google Scholar]
- Yokoyama K, Uchino M, Nakamura K, Ohtsuka H, Suzuki T, Boku T, Itoman M. Risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures. Injury 2006;37:554–60. doi:10.1016/j.injury.2005.08.026 [PubMed] [Google Scholar]