Cases reported "Fractures, Open"

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1/111. Salvage of open tibial fracture with segmental loss of tibial nerve: case report and review of the literature.

    We report a case history, treatment, and follow-up of an open comminuted distal tibial fracture with significant soft tissue loss and segmental loss of the tibial nerve and posterior tibial artery. This constellation of injuries with an insensate plantar foot has often been an indication for amputation. In this instance, a functional distal extremity was salvaged with the use of Ilizarov fixation, delayed primary tibial nerve cable grafting, and staged soft tissue coverage. Clinical follow-up and review of the literature on the techniques used are offered for consideration.
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2/111. Fibular nonunion and equinovarus deformity secondary to posterior tibial tendon incarceration in the syndesmosis: a case report after a bimalleolar fracture-dislocation.

    A 39-year-old woman sustained a grade II open bimalleolar fracture-dislocation of the left ankle. Six months after an ORIF of these fractures was performed, she presented with a nonunion of the distal fibula fracture and with a fixed hindfoot equinovarus and forefoot adduction deformity. At surgery for repair of the fibular nonunion, the posterior tibial tendon (PTT) was found to be entrapped in the posterior tibiotalar joint, with a portion of the tendon interposed between the tibia and the fibula in the area of the posterior syndesmosis. After extrication of the PTT, the hindfoot varus and forefoot adduction deformity were corrected. To our knowledge, this is the first case report in the English literature of a missed PTT syndesmotic entrapment that resulted in a fibular nonunion and in a fixed foot deformity after an open bimalleolar ankle fracture dislocation.
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keywords = tibia
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3/111. Prevention of skin and soft tissue entrapment in tibial segment transportation.

    We report of a ten year old patient with soft tissue damage and bone defect of the tibia as a sequel of osteomyelitis. After excision and stabilization with an Ilizarov fixateur segment transportation was started. In order to avoid skin and soft tissue entrapment in the docking region, we used a metal cage as a space provider, which was shortened as segment transportation progressed. To our knowledge this simple method has not been described so far.
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keywords = tibia
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4/111. Split free flap and monofixator distraction osteogenesis for leg reconstruction.

    The use of a split muscle flap widens the indications of unilateral external fixation in the treatment of type IIIB open tibial fractures with large bone defects. The same frame can be used for early stabilization and for secondary distraction lengthening procedures. The use of a split flap allows an easy, safe, and painless pin migration. The combination of these techniques represents a very safe solution, especially for patients in poor general and vascular condition.
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keywords = tibia
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5/111. Combined pedicled flaps for grade IIIB tibial fractures in children: a report of two patients.

    Severe open tibial fractures in children are associated with notable morbidity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruction in which large soft-tissue defects exist, as is often the case with grade IIIB fractures. In severe lower limb trauma, however, free flaps are associated with a relatively high risk of failure, particularly when definitive soft-tissue coverage is delayed. Alternative methods of soft-tissue reconstruction may, therefore, occasionally require consideration. The authors describe the combined use of three pedicled flaps to attain soft-tissue coverage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use for lower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; however, the aesthetic result is modest.
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keywords = tibia
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6/111. Successful free flap transfer following venous thrombectomy in recipient vessel.

    We report the case of a 53-year-old male patient who suffered a high velocity multiple trauma with bilateral open tibial fractures. At definitive orthopaedic and plastic surgical reconstruction 5 days post initial trauma, he was found peroperatively to have an existing deep venous thrombosis in his popliteal vein on one side. He underwent venous thrombectomy and had subsequent successful latissimus dorsi flap transfer using the unblocked popliteal vein as a recipient vessel.
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keywords = tibia
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7/111. Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula.

    A 43-year-old man sustained severe injuries to his lower limbs with extensive soft-tissue damage and bilateral tibial-fibular fractures. Acutely, the patient underwent external fixation and a free latissimus dorsi flap for soft-tissue coverage of the left leg. However, the tibia had a nonviable butterfly fragment that left a 7-cm defect after debridement. Subsequently, the contralateral fractured fibula was used as a bridging vascularized graft for this tibial defect. The transfer of a fibula containing the zone of injury from a previous high-energy fracture has not been reported. This case demonstrates the successful microvascular transfer of a previously fractured fibula for the repair of a contralateral tibial bony defect.
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keywords = tibia
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8/111. Use of an islanded fasciocutaneous flap in the lower limb following distraction callotasis.

    Severe limb injuries present a challenge to the attending surgeon and there has been an emergence of complex modes of treatment. The ilizarov technique for distraction osteogenesis is accepted as a worthwhile option in selected cases of massive segmental bone loss. The blood supply of the bone during this process has been studied experimentally but the response of the soft tissue envelope to the process of compression followed by slow and progressive elongation is not entirely understood. We present a case of lower limb trauma where a combined approach to reconstruction was required with acute shortening followed by distraction osteogenesis for a major segmental tibial defect. Late soft tissue reconstruction for persistent ulceration over the tibia was then undertaken using a distally based fasciocutaneous flap.
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ranking = 0.16666666666667
keywords = tibia
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9/111. Using the Ilizarov external fixation device for skin expansion.

    Addressing war injuries requires tailoring treatment that provides the best functional and aesthetic results within a reasonable period of time. The authors report a young soldier who sustained a gunshot injury that caused an open fracture of the proximal tibia and patella (Gustilo type B-III). A local muscle flap could not be used, and thus the authors decided to use the already applied Ilizarov device for gradual expansion of the wound edge. The expanded skin covered the exposed fracture successfully, and later enabled solid union of the fracture. This reconstructive method seems to be an original solution for the management of open fractures, and additional proof that well-vascularized skin may be equivalent to a muscle flap, and may be considered for selected patients.
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ranking = 0.083333333333333
keywords = tibia
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10/111. limb salvage of lower-extremity wounds using free gracilis muscle reconstruction.

    An extensive series reviewing the benefits and drawbacks of use of the gracilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic chronic wounds is reviewed. In addition, the wound size, injury patterns, problems, and results unique to the use of the gracilis as a donor muscle for lower-extremity reconstruction are identified. In a 7-year period from 1991 to 1998, 50 patients underwent lower-extremity reconstruction using microvascular free gracilis transfer at the University of maryland shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22 patients who underwent reconstruction for coverage of acute lower-extremity traumatic soft-tissue defects associated with open fractures. The majority of patients were victims of high-energy injuries with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successful limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a reliable and predictable tool in lower-extremity reconstruction, with a flap success and limb salvage rate comparable to those in other large studies.
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ranking = 0.16666666666667
keywords = tibia
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