ObjectiveTo compare the effectiveness of Taylor spatial frame (TSF) and unilateral external fixator in the treatment of tibiofibular open fractures.MethodsBetween January 2016 and July 2018, 74 patients with tibiofibular open fracture who met the selection criteria were divided into TSF group (43 cases, fixed with TSF) and unilateral group (31 cases, fixed with unilateral external fixator) according to the principle of entering the group every other day. There was no significant difference in gender, age, affected side, cause of injury, type of fracture between the two groups (P>0.05). The operation time, fracture healing time, removal time of external fixator, and complications were recorded and compared between the two groups. The limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effectiveness of tibial shaft fracture treatment. The recovery of lower limb force line was ecaluated by LUO Congfeng et al. criteria.ResultsAll patients were followed up 8-22 months, with a median of 12 months. All fractures healed, and no complication such as delayed union, nonunion, or osteomyelitis occurred. The operation time, fracture healing time, and removal time of external fixator in TSF group were significantly shorter than those in unilateral group (P<0.05). At 3 months after the removal of the external fixator, the limb function was evaluated according to the Johner-Wruhs standard. In TSF group, 41 cases were excellent, 1 case was good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 30 cases were excellent and 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups (P=0.666). At 4 months after operation, the recovery of lower limb force line was ecaluated by LUO Congfeng et al. criterion. In TSF group, 41 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 97.67%; in unilateral group, 29 cases were excellent, 1 case was good, 1 case was fair, and the excellent and good rate was 96.77%; there was no significant difference between the two groups (P=0.666).ConclusionFor tibiofibular open fracture, on the premise of fracture healing, TSF technology is superior to unilateral external fixation in terms of shortening operation time, fracture healing time, and removal time of external fixator.
Objective To investigate the effectiveness of minimally invasive hemi-cortical longitudinal bone transport technique for concurrent treatment of bone and soft tissue defects in patients with tibial osteomyelitis. Methods A retrospective analysis was conducted on 14 patients with tibial osteomyelitis accompanied by bone and skin soft tissue defects, who were admitted between January 2022 and August 2023. There were 10 males and 4 females, with an average age of 51.2 years (range, 35-75 years). Traumatic osteomyelitis was diagnosed in 11 cases, and hematogenous osteomyelitis in 3 cases. The duration of infection ranged from 0.2 to 1.9 months (mean, 1.1 months). All bone defects were rated as Orthopaedic Trauma Association (OTA) type Ⅰ. The length of bone defects ranged from 3.4 to 6.2 cm (mean, 4.8 cm); the width of defects corresponded to 1/4-1/2 of the tibial circumference. The extent of soft tissue defects ranged from 6.5 cm×2.0 cm to 7.0 cm×3.0 cm. Upon admission, primary debridement and antibiotic calcium sulfate bead filling of the medullary cavity were performed, followed by antibiotic-coated bone cement coverage for soft tissue defects. After infection control, secondary minimally invasive tibial osteotomy was performed, followed by Orthofix unilateral external fixator for upper limb use to facilitate bone tissue transport. The time required for external fixation and bone transport was recorded, and wound healing status, bone healing progress, and adjacent joint function were observed. Scoring was performed according to the Paley healing criteria. Results All patients completed two phases of treatment. The external fixation duration ranged from 2.1 to 6.5 months (mean, 4.5 months); bone transport duration ranged from 1.1 to 2.3 months (mean, 1.5 months); external fixation index ranged from 0.6 to 1.3 months/cm (mean, 0.98 months/cm). During bone transport, only 1 patient developed a pin tunnel reaction, with no other complications occurring. All patients were followed up 23-27 months (mean, 25.1 months). All wounds healed, with healing time ranging from 1.1 to 2.6 months (mean, 1.5 months); no infection recurrence was observed during follow-up. Imaging re-examination confirmed complete fracture healing, with healing time ranging from 2.6 to 3.5 months (mean, 3.2 months). At 3 months after discontinuation of bone transport, according to the Paley healing criteria, the bone healing in 14 patients achieved excellent; the joint function was rated as excellent in 11 patients and good in 3 patients. Conclusion The minimally invasive hemi-cortical longitudinal bone transport technique demonstrates satisfactory effectiveness in the concurrent treatment of bone and soft tissue defects following tibial osteomyelitis.
