The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma

Hohmann, Erik, Birkholtz, Franz, Glatt, Vaida and Tetsworth, Kevin (2017) The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma. Injury, . doi:10.1016/j.injury.2017.03.018


Author Hohmann, Erik
Birkholtz, Franz
Glatt, Vaida
Tetsworth, Kevin
Title The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma
Journal name Injury   Check publisher's open access policy
ISSN 1879-0267
0020-1383
Publication date 2017-03-18
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.injury.2017.03.018
Open Access Status File (Author Post-print)
Total pages 6
Place of publication London, United Kingdom
Publisher Elsevier
Collection year 2018
Language eng
Formatted abstract
Introduction

The purpose of this study was to describe a standardized staged approach, “The Road to Union”, for the reconstruction of isolated complex tibial trauma, both acute and chronic in nature.

Methods

This retrospective study included all patients treated for complex tibial trauma at a specialized limb reconstruction centre, including acute open fracture as well as infected and aseptic non-unions. This standardized approach includes eight specific steps, employed in sequence. The time in external fixation (EFT), the external fixation index (EFI), and the distraction consolidation index (DCI) were the primary outcome measures. The relationship between EFI and DCI was assessed using Pearson’s moment correlations.

Results

Thirty-two patients with a mean age of 34.7 ± 14.2 years were included; 12 were treated for complex open tibial fractures with bone loss, 13 for infected non-unions, and 6 for aseptic non-union. The mean bone defect was 66 ± 32 mm. The total EFT was 42.5 ± 14.8 weeks; the EFI measured 51.9 ± 25.3 days/cm, and the DCI measured 48.3 ± 21.4 days/cm. Union was achieved in 29 out of 32 patients (91%), and there was a strong and significant relationship between EFI and DCI (r = 0.92, p = 0.0001) measurements. Pin site infections were observed in 11 patients, and 3 patients had persistent non-union. Three patients underwent delayed amputations when reconstructive procedures were unable to achieve union.

Conclusion

The findings of this study demonstrate that a standardized staged treatment protocol of debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and functional rehabilitation can result in a high rate of union in cases of complex tibial trauma, both acute and chronic in nature.
Keyword Tibial fractures
Complex trauma
Bone loss
Nonunion
Infection
Bone transport
Limb reconstruction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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