Skip to main content
SpringerLink
Log in

Behandlung schwerster Tibiafrakturen mit gefährdetem Weichteilmantel und/oder Kontamination

Lebensqualität nach Einsatz des Ilizarov-Fixateur externe

Treatment of severe tibial fractures with extensive soft tissue damage and/or contamination

Quality of life after use of the Ilizarov external fixator

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Der Ilizarov-Fixateur externe (IF) bietet eine frühe und definitive Behandlungsmöglichkeit für schwere Frakturen der Tibia mit kompromittierten Weichteilen. Unser Ziel war es die Effizienz der Behandlung und speziell deren Einfluss auf die Lebensqualität der Patienten zu untersuchen.

Methode

Ein Fragebogen, welcher eine „SF-12 Health Survey“ beinhaltete, wurde an alle Patienten mit Tibiafrakturen versandt, welche zwischen Januar 2000 und Juni 2009 in unserer unfallchirurgischen Klinik einen IF erhielten.

Resultate

Den Fragebogen retournierten 48 Patienten, die einen IF zur primären Behandlung bei einer schweren Tibiafraktur erhalten haben. Die mediane Zeit bis zur Entfernung des IF war 154 (70–614) Tage. Die SF-12-Werte der Patienten ergaben für den mentalen Wert (MCS) einen durchschnittlichen Wert von 52 [Standardabweichung (SD) ± 12] und einen physischen Wert (PCS) von 38 (SD ± 11). Mit der Behandlung zufrieden waren 100% der Patienten und 91% würden sich wieder für diese Behandlung entscheiden.

Schlussfolgerung

Der IF zur primären und definitiven Behandlung von Tibiafrakturen mit kompromittiertem Weichteilmantel, bei welcher eine primäre interne Fixation kontraindiziert ist, zeigte in unserer Studie eine hohe Effizienz bezogen auf Frakturheilung und Zufriedenheit der Patienten.

Abstract

Background

The Ilizarov external fixator (IF) is an immediate and definitive treatment option for severe tibial fractures compromised by extensive soft tissue damage. The aim of this study was to assess the general performance of the IF and especially the impact on patient quality of life.

Method

A postal questionnaire including an SF-12 health survey and questions about various other aspects of quality of life was sent to all patients who received an IF for primary fracture treatment at a level 1 trauma centre between January 2000 and June 2009.

Results

A total of 48 completed questionnaires were received from patients treated with IF for severe tibial fractures. The median time to removal of the IF was 154 days (range 70-614 days). The mean SF-12 mental component score (MCS) was 52 (SD±12) and the mean physical component score (PCS) was 38 (SD±11). Of the patients 100 % answered that they were either satisfied or very satisfied with the treatment and 91 % would choose the same method of treatment under similar circumstances.

Conclusions

This study demonstrates a high performance of IF in the treatment of severe tibial fractures with compromised soft tissue where more standard forms of treatment are contraindicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Abdel-Aal AM (2006) Ilizarov bone transport for massive tibial bone defects. Orthopedics 29:70–74

    PubMed  Google Scholar 

  2. AO Foundation (2012) AO-Classification of long bone fractures. http://www.aofoundation.org

  3. Bacon S, Smith WR, Morgan SJ et al (2008) A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation. Injury 39:196–202

    Article  PubMed  Google Scholar 

  4. Catagni MA, Ottaviani G, Maggioni M (2007) Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 63:1043–1053

    Article  PubMed  Google Scholar 

  5. Cavusoglu AT, Er MS, Inal S et al (2009) Pin site care during circular external fixation using two different protocols. J Orthop Trauma 23:724–730

    Article  PubMed  Google Scholar 

  6. Haines DA (2008) Ilizarov & external fixator wearers support group. http://www.ilizarov.org

  7. Dendrinos GK, Kontos S, Katsenis D et al (1996) Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg Br 78:710–717

    CAS  PubMed  Google Scholar 

  8. Endres T, Grass R, Biewener A et al (2004) Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures. Unfallchirurg 107:273–284

    Article  CAS  PubMed  Google Scholar 

  9. Gessmann J, Seybold D, Baecker H et al (2009) Operative management and fracture care of the lower leg with the Ilizarov fixator in morbidly obese patients: literature review and results. Chirurg 80:34–44

    Article  CAS  PubMed  Google Scholar 

  10. Giotakis N, Panchani SK, Narayan B et al (2010) Segmental fractures of the tibia treated by circular external fixation. J Bone Joint Surg Br 92:687–692

    Article  CAS  PubMed  Google Scholar 

  11. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746

    Article  CAS  PubMed  Google Scholar 

  12. Inan M, Halici M, Ayan I et al (2007) Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing. Arch Orthop Trauma Surg 127:617–623

    Article  PubMed  Google Scholar 

  13. Kapoor SK, Kataria H, Patra SR et al (2010) Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures. J Bone Joint Surg Br 92:1100–1106

    Article  CAS  PubMed  Google Scholar 

  14. Kiely JM, Brasel KJ, Guse CE et al (2006) Correlation of SF-12 and SF-36 in a trauma population. J Surg Res 132:214–218

    Article  PubMed  Google Scholar 

  15. Kumar P, Singh GK, Bajracharya S (2007) Treatment of grade IIIB opens tibial fracture by Ilizarov hybrid external fixator. Kathmandu Univ Med J (KUMJ) 5:177–180

    Google Scholar 

  16. Mekhail AO, Abraham E, Gruber B et al (2004) Bone transport in the management of posttraumatic bone defects in the lower extremity. J Trauma 56:368–378

    Article  PubMed  Google Scholar 

  17. Modin M, Ramos T, Stomberg MW (2009) Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation. J Clin Nurs 18:3498–3506

    Article  PubMed  Google Scholar 

  18. Ozturkmen Y, Karamehmetoglu M, Karadeniz H et al (2009) Acute treatment of segmental tibial fractures with the Ilizarov method. Injury 40:321–326

    Article  PubMed  Google Scholar 

  19. Shtarker H, David R, Stolero J et al (1997) Treatment of open tibial fractures with primary suture and Ilizarov fixation. Clin Orthop Relat Res 335:268–274

    PubMed  Google Scholar 

  20. Vidyadhara S, Rao SK (2006) Ilizarov treatment of complex tibial pilon fractures. Int Orthop 30:113–117

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Watson JT, Coufal C (1998) Treatment of complex lateral plateau fractures using Ilizarov techniques. Clin Orthop Relat Res 353:97–106

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, North block, Level 5, Wellington Street, 6000, Perth, WA, Australien

    D. Baschera, M. Wren MB BS, FRACS & R. Zellweger

  2. Kantonsspital Schaffhausen, Schaffhausen, Schweiz

    C. Walter

Authors
  1. D. Baschera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Walter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Wren MB BS, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Zellweger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Baschera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baschera, D., Walter, C., Wren, M. et al. Behandlung schwerster Tibiafrakturen mit gefährdetem Weichteilmantel und/oder Kontamination . Unfallchirurg 117, 420–427 (2014). https://doi.org/10.1007/s00113-012-2342-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-012-2342-5

Schlüsselwörter

Keywords

Search

Navigation