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Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Salvage or amputation for grade 3C open fracture of tibia is not well responded question universally because of surgical innovations, cultural believes, difficulties in estimate the outcome, coasts, and different results in the literature. The aim of this study was to evaluate the surgical outcomes of Gustilo grade 3C open tibia fractures with at least two years follow-up in non-military adults.

Methods

Twenty-two non-military patients with a mean age of 31.1 were operated with grade 3c open fractures at tibia level in last 10 years in our clinic. We evaluated them retrospectively and asked about their daily life, pain, and if present, about the wish for secondary amputation. We also asked if they would prefer a first day amputation rather than their present status.

Results

Mean operation time after the injury was 13 h. Seven patients had nerve injury. Mean operation number was 3.5. Eight patients (%36) (all due to circulatory problem) had to have amputation. All patients treated with temporary unilateral external fixation than converted to circular external fixators when soft tissue healing was completed. Two patients were reoperated because of deformity. Four patients needed revision surgery because of non-union. At long term follow, we had osteomyelitis in one patient.

Conclusions

Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.

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References

  1. MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the lower extremity assessment project (LEAP). J Am Acad Orthop Surg. 2006;14:S205–10.

    Article  PubMed  Google Scholar 

  2. Allen MJ, et al. Major vascular injuries associated with orthopaedic injuries to the lower limb. Ann R Coll Surg Engl. 1984;66(2):101–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Howe HR Jr, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53(4):205–8.

    PubMed  Google Scholar 

  4. DiChristina DG, et al. Femur fractures with femoral or popliteal artery injuries in blunt trauma. J Orthop Trauma. 1994;8(6):494–503.

    Article  CAS  PubMed  Google Scholar 

  5. Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987;10(12):1781–8.

    CAS  PubMed  Google Scholar 

  6. Helfet DL, et al. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res. 1990;256:80–6.

    Google Scholar 

  7. Russell WL et al. (1991) Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg. 1991;213(5):473–80; discussion 480-1.

  8. Seekamp A, Kontopp H, Tscherne H. Hannover Fracture Scale ‘98–reevaluation and new prospects for an established score system. Unfallchirurg. 2001;104(7):601–10.

    Article  CAS  PubMed  Google Scholar 

  9. Fodor L, et al. Mangled lower extremity: can we trust the amputation scores? Int J Burns Trauma. 2012;2(1):51–8.

    PubMed  PubMed Central  Google Scholar 

  10. Ware JE and Kosinski M., SF-36 Physical and Mental Health Summary Scales: A Manual for Users of Version 1, Second Edition. QualityMetric Incorporated; Lincoln, RI.: 2001a.

  11. Levy BA, et al. Screening for extermity arterial injury with the arterial pressure index. Am J Emerg Med. 2005;23(5):689–95.

    Article  PubMed  Google Scholar 

  12. Johansen K, et al. Non-invasive vascular tests reliably exclude occult arterial trauma in injured extremities. J Trauma. 1991;31(4):515–9 (discussion 519-22).

    Article  CAS  PubMed  Google Scholar 

  13. Flint LM, Richardson JD. Arterial injuries with lower extremity fracture. Surgery. 1983;93(1 Pt 1):5–8.

    CAS  PubMed  Google Scholar 

  14. Modrall JG, Weaver FA, Yellin AE. Diagnosis and management of penetrating vascular trauma and the injured extremity. Emerg Med Clin North Am. 1998;16(1):129–44.

    Article  CAS  PubMed  Google Scholar 

  15. Mullenix PS, et al. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006;44(1):94–100.

    Article  PubMed  Google Scholar 

  16. Reber PU, et al. Selective use of temporary intravascular shunts in coincident vascular and orthopedic upper and lower limb trauma. J Trauma. 1999;47(1):72–6.

    Article  CAS  PubMed  Google Scholar 

  17. Glass GE, Pearse MF, Nanchahal J. Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm. J Plast Reconstr Aesthet Surg. 2009;62(5):571–9.

    Article  CAS  PubMed  Google Scholar 

  18. Drost TF, et al. Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity. J Trauma. 1989;29(10):1331–4.

    Article  CAS  PubMed  Google Scholar 

  19. Moniz MP, et al. Concomitant orthopedic and vascular injuries as predictors for limb loss in blunt lower extremity trauma. Am Surg. 1997;63(1):24–8.

    CAS  PubMed  Google Scholar 

  20. Rosental JJ, et al. Vascular injuries associated with fractures of the femur. Arch Surg. 1975;110(5):494–9.

    Article  CAS  PubMed  Google Scholar 

  21. Cakir O, et al. Treatment of vascular injuries associated with limb fractures. Ann R Coll Surg Engl. 2005;87(5):348–52.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ashworth EM, et al. Lower extremity vascular trauma: a comprehensive, aggressive approach. J Trauma. 1988;28(3):329–36.

    Article  CAS  PubMed  Google Scholar 

  23. McHenry TP, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma. 2002;53(4):717–21.

    Article  PubMed  Google Scholar 

  24. Iannacone WM, et al. Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation. J Trauma. 1994;37(3):446–51.

    Article  CAS  PubMed  Google Scholar 

  25. Kluger Y, et al. Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma. 1994;36(2):222–5.

    Article  CAS  PubMed  Google Scholar 

  26. Fowler J, et al. The importance of surgical sequence in the treatment of lower extremity injuries with concomitant vascular injury: a meta-analysis. Injury. 2009;40(1):72–6.

    Article  PubMed  Google Scholar 

  27. Kootstra G, et al. Femoral shaft fracture with injury of the superficial femoral artery in civilian accidents. Surg Gynecol Obstet. 1976;142(3):399–403.

    CAS  PubMed  Google Scholar 

  28. Bishara RA, et al. Improved results in the treatment of civilian vascular injuries associated with fractures and dislocations. J Vasc Surg. 1986;3(5):707–11.

    Article  CAS  PubMed  Google Scholar 

  29. Waikakul S, Sakkarnkosol S, Vanadurongwan V. Vascular injuries in compound fractures of the leg with initially adequate circulation. J Bone Joint Surg Br. 1998;80(2):254–8.

    Article  CAS  PubMed  Google Scholar 

  30. Kuralay E, et al. A quantitative approach to lower extremity vein repair. J Vasc Surg. 2002;36(6):1213–8.

    Article  PubMed  Google Scholar 

  31. Seligson D, et al. The management of open fractures associated with arterial injury requiring vascular repair. J Trauma. 1994;37(6):938–40.

    Article  CAS  PubMed  Google Scholar 

  32. Guerrero A, et al. Limb loss following lower extremity arterial trauma: what can be done proactively? Injury. 2002;33(9):765–9.

    Article  PubMed  Google Scholar 

  33. Rerkasem K, Arworn S, Thepmalai K. Prognostic factors of leg amputation in patients with vascular injury: a systematic review. Int J Low Extrem Wounds. 2006;5(2):78–82.

    Article  CAS  PubMed  Google Scholar 

  34. Yeager RA, et al. Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates. Am Surg. 1984;50(3):155–8.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

    O. Tunali, H. I. Balci & O. Yazicioglu

  2. Department of Orthopedics and Traumatology, Biruni University, Istanbul, Turkey

    Y. Saglam

  3. Department of Orthopedics and Traumatology, Sakarya University, Sakarya, Turkey

    A. Kochai

  4. General Surgery Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey

    N. A. Sahbaz

  5. Department of Cardiovascular Surgery, Istanbul Medical Faculty, Stanbul University, Istanbul, Turkey

    O. A. Sayin

Authors
  1. O. Tunali
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  2. Y. Saglam
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  3. H. I. Balci
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  4. A. Kochai
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  5. N. A. Sahbaz
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  6. O. A. Sayin
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  7. O. Yazicioglu
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Corresponding author

Correspondence to O. Tunali.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

This study was approved by the institutional review board (IRB) of the Istanbul University, Istanbul Faculty of Medicine and has been done in Istanbul Medical Faculty, Department of Orthopedics and Traumatology, This study has not been published elsewhere before. It is not accepted for publication and under consideration by another publication. Each author (Onur Tunali, Halil Ibrahim Balci, Yavuz Saglam, Alauddin Kochai, Nuri Alper Sahbaz, Omer Ali Sayin and Onder Yazicioglu) certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Tunali, O., Saglam, Y., Balci, H.I. et al. Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up. Eur J Trauma Emerg Surg 43, 505–512 (2017). https://doi.org/10.1007/s00068-016-0689-y

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  • DOI: https://doi.org/10.1007/s00068-016-0689-y

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