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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1]. [1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India Address of Correspondence Dr. Mangesh Panat, Dept. of orthopedics, mgm medical college and hospital. […]

Fractures of the distal end of humerus treated with joshi external stabilizing system

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 8-11 | Meganath Pawar, Mohammed Ibrahim Author: Meganath Pawar [1], Mohammed Ibrahim [2]. [1]Department of Orthopaedics, ESIC Medical College, Gulbarga, Karnataka, India, [2]Department of Orthopaedics, GIMS Medical College, Gulbarga, Karnataka, India. Address of Correspondence Dr. Mohammed Ibrahim Department of Orthopaedics, GIMS Medical College, Gulbarga, […]

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Fractures of the distal end of humerus treated with joshi external stabilizing system

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni

Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

[1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India

Address of Correspondence
Dr. Mangesh Panat,
Dept. of orthopedics, mgm medical college and hospital.
Email: mangeshpanat@yahoo.co.in

Learning Points for this Article: This article will focus on successful management of proximal tibia fractures with impending compartment syndrome in two stages supporting the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.

Abstract

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting.
Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries.
Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries.
Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection.
Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.

References

1. Dougherty PJ, Silverton C, Yeni Y, Tashman S, Weir R. Conversion from temporary external fixation to definitive fixation: Shaft fractures. J Am Acad Orthop Surg 2006;14:S124-S127.
2. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 1997;11(7):484-489.
3. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84(9):1541-1551.
4. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 2004;18(8):521-527.
5. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005;439:207-214.
6. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthop Trauma 2005;19(7):448-455.
7. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 2000;78-90.
8. Haidukewych GJ, Collinge CA. Conversion of Temporary External Fixation to Formal Internal Fixation for Complex per Articular Injuries of the Lower Extremity: Is there an Infection risk? Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Dallas, Texas; 2002.

How to Cite this article: Qureshi MS, Panat M, Israni P. Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation. Trauma International Sep-Dec 2017;3(2):16-20.

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Fractures of the distal end of humerus treated with joshi external stabilizing system

December 10, 2017/in Volume 3 | Issue 2 | Sep-Dec

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 8-11 | Meganath Pawar, Mohammed Ibrahim

Author: Meganath Pawar [1], Mohammed Ibrahim [2].

[1]Department of Orthopaedics, ESIC Medical College, Gulbarga, Karnataka, India,
[2]Department of Orthopaedics, GIMS Medical College, Gulbarga, Karnataka, India.

Address of Correspondence
Dr. Mohammed Ibrahim
Department of Orthopaedics, GIMS Medical College, Gulbarga, Karnataka, India.
Email: dribrahimparvez@gmail.com

Learning Points for this Article: Application of simple and easy method for treated of complex fractures at peripheral level

Abstract

Fracture of the distal humerus is a common and debilitating injury and accounts for 2% of all adult fractures. Patients with displaced, unstable distal humeral fractures may have improved outcomes if managed operatively.
Objectives: The objectives were aimed to study the results of using Joshi’s external stabilizing system (JESS) for the management of fractures of distal humerus.
Materials and Methods: This prospective study was conducted in GGHGulbarga on 15 subjects with distal humerus fractures. As per AO classification,C typefractures were included and prepared for JESS fixation. The results of the treatment were evaluated as per Cassebaum functional criteria. Patients were followed up for 12 months.
Results: Among15 patients, 9 males and 6 females, 6 hadC1, 6 had C2, and 3 had C3. Mean duration of JESS application was 8 weeks. Among 15 patients,10 had excellent, 3 had satisfactory result, and 2 had unsatisfactory result.
Conclusion: JESS is an alternativesimple and easyoption for the treatment of distal humerus fractures, showing excellent to good results in cases of AO C1, C2, and C3 fracture.
Keywords: Distal humerus intracondylar, Joshi’s external stabilizing system.

References

1. Babhulkar S, Babhulkar S. Controversies in the management of intra-articular fractures of distal humerus in adults. Indian J Orthop2011;45(3):216-225.
2. Galano GJ, Ahmad CS, Levine WN. Current treatment strategies for bicolumnar distal humerus fractures. J Am AcadOrthopSurg2010;18(1):20-30.
3. Safoury YA, Atteya MR. Treatment of post-infection nonunion of the supracondylar humerus with Ilizarov external fixator. J Shoulder Elbow Surg2011;20(6):873-879.
4. Zlotolow DN, Catalano LW, Barron OA,Glickel SZ. Surgical exposure of the humerus. J Am AcadOrthopSurg2006;14(13):754-765.
5. Qureshi KK, Sabir MR, Yasin G. Assessment of elbow function after stable fixation of AO Type C fracture of the distal humerus in adults. Prof Med J 2005;12:331-335.
6. Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am AcadOrthopSurg2009;17(5):325-333.
7. O’Driscoll SW, Sanchez-Sotelo J, Torchia ME. Management of the smashed distal humerus. OrthopClin North Am2002;33:19-33, vii.
8. Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: Internal fixation with a principle-based parallel-plate technique. Surgical technique. J Bone Joint Surg Am2008;90Suppl 2:31-46.

How to Cite this article: Pawar M, Ibrahim M. Fractures of the Distal End of Humerus Treated with Joshi External Stabilizing System. Trauma International Sep-Dec 2017;3(2):8-11.

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Half Sized Blog Element (Multi Author Style)

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Fractures of the distal end of humerus treated with joshi external stabilizing system

Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Fractures of the distal end of humerus treated with joshi external stabilizing system

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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

Fractures of the distal end of humerus treated with joshi external stabilizing system

Author: Meganath Pawar [1], Mohammed Ibrahim [2].

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

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