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Clinical outcome of open grade IIIC lower extremity fractures
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Abstracts / Injury Extra 42 (2011) 95–169
Results: 88 patients were trialled between May 2007 and April 2010. 80% (n = 70) of patients were successfully treated as day cases, 17% (n = 15) were discharged on the day of operation but required hospital beds for out-of-hours management and 3% (n = 3) required overnight admission. 58% (n = 51) of patients were successfully contacted within a week of operation. 94% (n = 48) achieved good postoperative pain control, experiencing no or mild pain only. 2% (n = 1) experienced other post-operative symptoms, such as nausea. 100% of patients were satisfied with their treatment. 100% of patients were happy their procedure was completed as a day case. Conclusion: ACL tears are common traumatic injuries. We conclude that the significant majority of ACL reconstructions can successfully be completed as a day case procedures, reducing the need for hospital. doi:10.1016/j.injury.2011.06.325 2B.1 Are we flatfooted in our investigation of acute foot injuries? M.T. O’Flaherty, R.A. Wilson Orthopaedic Trauma Unit, Royal Victoria Hospital, Belfast, Ireland Objective: To assess the usefulness of radiographs alone to evaluate acute midfoot/forefoot injuries. We believe that foot injuries are often under-estimated and that CT scans should be routinely obtained to aid in their management and avoid additional morbidity for patients. Materials and methods: In 26 months, 255 patients had foot injuries requiring X-rays. Of these patients, 94 (37%) had primary radiographs indicating midfoot or forefoot fractures, and 28 had subsequent CT scans. Radiographs were retrospectively reevaluated with respect to fracture location, type, mechanism of injury and then compared with CT results. Results: Of 255 patients, 213 (84%) had one or more fractures in their foot. A total of 397 fractures were seen with 105 patients having Os Calcis (41%) fractures. 94 patients (37%) had midfoot/forefoot fractures which included the 28 patients with subsequent CT scans. 56 patients (22%) had no injury. Of those patients with midfoot/forefoot injuries, 61 fractures were seen on plain radiographs and an additional 74 were identified on CT scanning. The major mechanism of injury in these patients was Road Traffic Accident (26 patients [28%]). Commonly missed individual fractures on plain radiography were Metatarsal (29), Cuboid (12) and Cuneiform fractures (11). Nine of the 29 (31%) metatarsal bone fractures involved missed fracture-dislocations of the Lisfranc joint. Other new fractures included Talus (4), Navicular (3), Os Calcis (2) and Tibia (2). 48 required operative fixation, including 20 patients that underwent CT scanning. We found that the sensitivity of radiographs in detection of midfoot fractures was low at 44%, and only 50% in forefoot injuries. Conclusion: In patients with high energy foot injury, and those with suspected complex injury, the sensitivity of radiography is only moderate at best. We suggest that CT scanning as the primary imaging modality would lead to a decrease in their morbidity. doi:10.1016/j.injury.2011.06.326
2B.2 Clinical outcome of open grade IIIC lower extremity fractures N.K. Kanakaris, M. Mokawem, K. Tzafetta, S. Kay, P.V. Giannoudis Academic Department of Trauma and Orthopaedics & Department of Plastic Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK Purpose–introduction: The experience of a regional tertiary referral centre for complex limb reconstruction and plastic surgery from managing open fractures of the lower extremities with associated vascular injury – Gustilo IIIc is presented. Methods and materials: Retrospective cohort of open IIIc lower extremity fractures, managed between 1991 and 2006. Data regarding demographics, inpatient hospitalisation, treatment, post-operative course and complications were collected referring to a mean period of follow-up of 25 months. ISS/AIS-05, MESS score, EuroQol-5D were used to quantify the parameters. SPSS-09 was used to perform linear regression, t-paired test and correlation analysis. Results: Eighteen patients, 15 males, of a mean age of 34.7 years, ISS = 13 (9–45), MESS = 6.9 (3–10), LOS = 24.5 days (5–105). Three ended to an amputation, 4 ex-fixed, 8 plated, 5 nailed. The mean number of repaired vessels was 1.6, with most common the posterior tibialis. Rotational flaps were used in 3, free flaps in 6, while another 3 were closed primarily. Seven developed wound infections, and four nonunions. According to the EuroQol subparameters physical health (p = 0.001) and depression (p = 0.003) limited social activities in 61% of the cases, mobility was correlated to MESS (p = 0.002). Conclusion: Open IIIc lower extremity fractures represent the most complex of open injuries requiring optimal initial management, and early referral to specialist tertiary centres. Multidisciplinary teams need to be involved early; the “fix and flap” protocol is feasible in these conditions, while MESS can be a predictor of functional outcome. doi:10.1016/j.injury.2011.06.327 2B.3 The natural progression of isolated Weber B fibular fractures: A radiographic audit J.D. May, L.R. McGrath Chesterfield Royal NHS Foundation Trust, Calow, Chesterfield, Derbyshire, UK Purpose: The purpose of this audit was to examine the risk of displacement of a Weber B fibular fracture with no initial displacement. Method: Patients seen initially as outpatients with an ankle fracture between April 2009 and April 2010 were identified by clinical codes. Their X-ray records were reviewed. Patients admitted primarily for inpatient treatment (usually surgical) were not included (174 patients in the study period). Only isolated Weber B fibular fractures with no significant displacement on the initial films were included in this study. Sequential X-rays were studied to look for displacement of these fractures, occurring after the initial X-ray. Results: Of 201 patients identified, there were 59 Weber B fibular fractures, of which 49 met our study criteria. 2 (4%) patients demonstrated talar shift on films taken after the application of a cast.
Abstracts / Injury Extra 42 (2011) 95–169
Results: 88 patients were trialled between May 2007 and April 2010. 80% (n = 70) of patients were successfully treated as day cases, 17% (n = 15) were discharged on the day of operation but required hospital beds for out-of-hours management and 3% (n = 3) required overnight admission. 58% (n = 51) of patients were successfully contacted within a week of operation. 94% (n = 48) achieved good postoperative pain control, experiencing no or mild pain only. 2% (n = 1) experienced other post-operative symptoms, such as nausea. 100% of patients were satisfied with their treatment. 100% of patients were happy their procedure was completed as a day case. Conclusion: ACL tears are common traumatic injuries. We conclude that the significant majority of ACL reconstructions can successfully be completed as a day case procedures, reducing the need for hospital. doi:10.1016/j.injury.2011.06.325 2B.1 Are we flatfooted in our investigation of acute foot injuries? M.T. O’Flaherty, R.A. Wilson Orthopaedic Trauma Unit, Royal Victoria Hospital, Belfast, Ireland Objective: To assess the usefulness of radiographs alone to evaluate acute midfoot/forefoot injuries. We believe that foot injuries are often under-estimated and that CT scans should be routinely obtained to aid in their management and avoid additional morbidity for patients. Materials and methods: In 26 months, 255 patients had foot injuries requiring X-rays. Of these patients, 94 (37%) had primary radiographs indicating midfoot or forefoot fractures, and 28 had subsequent CT scans. Radiographs were retrospectively reevaluated with respect to fracture location, type, mechanism of injury and then compared with CT results. Results: Of 255 patients, 213 (84%) had one or more fractures in their foot. A total of 397 fractures were seen with 105 patients having Os Calcis (41%) fractures. 94 patients (37%) had midfoot/forefoot fractures which included the 28 patients with subsequent CT scans. 56 patients (22%) had no injury. Of those patients with midfoot/forefoot injuries, 61 fractures were seen on plain radiographs and an additional 74 were identified on CT scanning. The major mechanism of injury in these patients was Road Traffic Accident (26 patients [28%]). Commonly missed individual fractures on plain radiography were Metatarsal (29), Cuboid (12) and Cuneiform fractures (11). Nine of the 29 (31%) metatarsal bone fractures involved missed fracture-dislocations of the Lisfranc joint. Other new fractures included Talus (4), Navicular (3), Os Calcis (2) and Tibia (2). 48 required operative fixation, including 20 patients that underwent CT scanning. We found that the sensitivity of radiographs in detection of midfoot fractures was low at 44%, and only 50% in forefoot injuries. Conclusion: In patients with high energy foot injury, and those with suspected complex injury, the sensitivity of radiography is only moderate at best. We suggest that CT scanning as the primary imaging modality would lead to a decrease in their morbidity. doi:10.1016/j.injury.2011.06.326
2B.2 Clinical outcome of open grade IIIC lower extremity fractures N.K. Kanakaris, M. Mokawem, K. Tzafetta, S. Kay, P.V. Giannoudis Academic Department of Trauma and Orthopaedics & Department of Plastic Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK Purpose–introduction: The experience of a regional tertiary referral centre for complex limb reconstruction and plastic surgery from managing open fractures of the lower extremities with associated vascular injury – Gustilo IIIc is presented. Methods and materials: Retrospective cohort of open IIIc lower extremity fractures, managed between 1991 and 2006. Data regarding demographics, inpatient hospitalisation, treatment, post-operative course and complications were collected referring to a mean period of follow-up of 25 months. ISS/AIS-05, MESS score, EuroQol-5D were used to quantify the parameters. SPSS-09 was used to perform linear regression, t-paired test and correlation analysis. Results: Eighteen patients, 15 males, of a mean age of 34.7 years, ISS = 13 (9–45), MESS = 6.9 (3–10), LOS = 24.5 days (5–105). Three ended to an amputation, 4 ex-fixed, 8 plated, 5 nailed. The mean number of repaired vessels was 1.6, with most common the posterior tibialis. Rotational flaps were used in 3, free flaps in 6, while another 3 were closed primarily. Seven developed wound infections, and four nonunions. According to the EuroQol subparameters physical health (p = 0.001) and depression (p = 0.003) limited social activities in 61% of the cases, mobility was correlated to MESS (p = 0.002). Conclusion: Open IIIc lower extremity fractures represent the most complex of open injuries requiring optimal initial management, and early referral to specialist tertiary centres. Multidisciplinary teams need to be involved early; the “fix and flap” protocol is feasible in these conditions, while MESS can be a predictor of functional outcome. doi:10.1016/j.injury.2011.06.327 2B.3 The natural progression of isolated Weber B fibular fractures: A radiographic audit J.D. May, L.R. McGrath Chesterfield Royal NHS Foundation Trust, Calow, Chesterfield, Derbyshire, UK Purpose: The purpose of this audit was to examine the risk of displacement of a Weber B fibular fracture with no initial displacement. Method: Patients seen initially as outpatients with an ankle fracture between April 2009 and April 2010 were identified by clinical codes. Their X-ray records were reviewed. Patients admitted primarily for inpatient treatment (usually surgical) were not included (174 patients in the study period). Only isolated Weber B fibular fractures with no significant displacement on the initial films were included in this study. Sequential X-rays were studied to look for displacement of these fractures, occurring after the initial X-ray. Results: Of 201 patients identified, there were 59 Weber B fibular fractures, of which 49 met our study criteria. 2 (4%) patients demonstrated talar shift on films taken after the application of a cast.