Seung-Ryul Lee; Jae-Hoon Yang; June-Kyu Lee; Hyun-Dae Shin; Kyung-Cheon Kim; Kyu-Woong Yeon; Young-Mo Kim

doi:10.12671/jkfs.2009.22.3.152

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Original Article
Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage: Seung-Ryul Lee, M.D., Jae-Hoon Yang, M.D., June-Kyu Lee, M.D., Hyun-Dae Shin, M.D., Kyung-Cheon Kim, M.D., Kyu-Woong Yeon, M.D., Young-Mo Kim, M.D.; Journal of the Korean Fracture Society 2009;22(3):152-158.
DOI: https://doi.org/10.12671/jkfs.2009.22.3.152
Published online: July 31, 2009

Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

^*Department of Plastic and Reconstructive Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

Address reprint requests to: Young-Mo Kim, M.D. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 640, Daesa-dong, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7352, Fax: 82-42-252-7098, osdr69@cnu.ac.kr

• Received: November 2, 2008 • Revised: December 12, 2008 • Accepted: May 3, 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates.
Materials and Methods
The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue.
Results
The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness.
Conclusion
In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.
Key words: Proximal tibia fracture, High energy injury, Soft tissue injury, External fixator, Plate fixation

REFERENCES

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Fig. 1

53 year-old man with a proximal tibia fracture (AO/OTA type C2) by a pedestrian traffic accident.

(A, B) Preoperative anteroposterior and lateral radiographs showing the comminution and the lateral condylar depression, (C) and the swelling of knee joint and surrounding soft tissues were severe.

(D, E) External fixation was performed after the day of accident, and these postoperative radiographs shows well aligned fracture fragments.

(F, G) Internal fixation was performed after 17 days, and these radiographs shows firm fixation with a lateral periarticular plate and additional K-wire fixation to preserve the articular line of the knee.

Fig. 2

45 year-old man with a proximal tibia fracture (AO/OTA type C3, open GIIIb) by a motorcycle traffic accident. Preoperative anteroposterior and lateral radiographs showing the splitting of the tibial condyle and severe comminuted, displaced fragments.

(A, B) The soft tissue defect was about 25×10 cm as shown, (C, D) and after copious irrigation and wide marginal debridement was performed at operation room, external fixation was performed immediately.

(E, F) Internal fixation was performed after 9 days, and anterolateral thigh free flap was performed by plastic surgeons concurrently.

(G, H) The radiographs shows fixation with lateral periarticular plate medial locking compression plate and relatively preserved articular surface of the knee.

Fig. 3

The 12 months follow up (A) anteroposterior and (B) lateral radiographs of the patient described in Fig. 1. The articular surface was congruent and union was achieved successfully. The range of motion was 5 to 120 degree, and patient had mild pain on knee when forceful flexion and extension was performed.

Fig. 4

The 30 months follow up (A) anteroposterior and (B) lateral radiographs of the patient described in Fig. 2. The articular surface was congruent and union was achieved successfully. The range of motion was 0 to 130 degrees, but the patient suffered in pain when full weight bearing was performed.

Table 1

Summary of cases

Table 2

Types of soft tissue reconstructions

Table 3

Summary of complications

Figure & Data

REFERENCES

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

J Korean Fract Soc. 2009;22(3):152-158. Published online July 31, 2009

DOI: https://doi.org/10.12671/jkfs.2009.22.3.152

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Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

Fig. 1 53 year-old man with a proximal tibia fracture (AO/OTA type C2) by a pedestrian traffic accident. (A, B) Preoperative anteroposterior and lateral radiographs showing the comminution and the lateral condylar depression, (C) and the swelling of knee joint and surrounding soft tissues were severe. (D, E) External fixation was performed after the day of accident, and these postoperative radiographs shows well aligned fracture fragments. (F, G) Internal fixation was performed after 17 days, and these radiographs shows firm fixation with a lateral periarticular plate and additional K-wire fixation to preserve the articular line of the knee.

Fig. 2 45 year-old man with a proximal tibia fracture (AO/OTA type C3, open GIIIb) by a motorcycle traffic accident. Preoperative anteroposterior and lateral radiographs showing the splitting of the tibial condyle and severe comminuted, displaced fragments. (A, B) The soft tissue defect was about 25×10 cm as shown, (C, D) and after copious irrigation and wide marginal debridement was performed at operation room, external fixation was performed immediately. (E, F) Internal fixation was performed after 9 days, and anterolateral thigh free flap was performed by plastic surgeons concurrently. (G, H) The radiographs shows fixation with lateral periarticular plate medial locking compression plate and relatively preserved articular surface of the knee.

Fig. 3 The 12 months follow up (A) anteroposterior and (B) lateral radiographs of the patient described in Fig. 1. The articular surface was congruent and union was achieved successfully. The range of motion was 5 to 120 degree, and patient had mild pain on knee when forceful flexion and extension was performed.

Fig. 4 The 30 months follow up (A) anteroposterior and (B) lateral radiographs of the patient described in Fig. 2. The articular surface was congruent and union was achieved successfully. The range of motion was 0 to 130 degrees, but the patient suffered in pain when full weight bearing was performed.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Staged Management of High Energy Proximal Tibia Fractures with Severe Soft Tissue Damage

Table 1

Summary of cases

Table 2

Types of soft tissue reconstructions

Table 3

Summary of complications

Table 1 Summary of cases

Table 2 Types of soft tissue reconstructions

Table 3 Summary of complications