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Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children
Letters to the Editor
Corresponding author. Tel.: +44 7786473361 E-mail addresses: [email protected] (Muhammad Shakil Akhtar) [email protected] (Munir Khan) [email protected] (Mohammad Waseem) 1 Tel.: +44 1625421000; Bleep:5073 2 Tel.: +44 1625824874 29 July 2004
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are not seen. According to our unpublished data, we have obtained successful results in eight cases treated with early cross-leg flap. Our findings indicates that all early cross-leg flaps were successful and remained durable with no history of breakdown, and none of the children developed systemic complications or infection.
Reference
10.1016/j.injury.2004.07.030 1. Fujita M, Yokoyama K, Nakamura K, Uchino M, Wakita R, Itoman M. Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children. Injury 2004;35:272—7.
LETTER TO THE EDITOR Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children I read with interest the article in the March 2004 issue entitled ‘Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children’ by Fujita et al.1 The issue was evaluated very well, however I think that there is still need for additional knowledge about the cause of injuries and management of soft-tissue reconstruction. As the authors stated, The mechanism of the tibial fracture was presumed to be a direct hit sustained from the vehicle or tyre, and that of crushed foot structures was presumed to be torsional and compressive forces caused by tyres rolling over the feet. However, we have thought in our cases that tyres had caused deep injury including periost and cortex of the bone due to breaking effect of the vehicle while rolling over the feet. According to Gustillo classification, our patients with Type IIIB injury patients were immediately taken to the operating where all wounds were copiously irrigated and a more formal debridement was performed in the operating room. The ruptured extensor tendon was sutured to surrounding tissues in a neutral position. Parenteral antibiotic therapy, usually a cephalosporin administered for 7 days are used to counteract possible infection. Soft tissues of the crushed dorsal foot were managed cross-leg flaps. We think that cross-leg flap lead to less scaring with well excursion of the underlying tendons, and provide optimal coverage over exposed tendons and bones. Furthermore, early covering of open bone and tendons with cross-leg flap acts as an excellent biological dressing at the emergency stage, providing a further barrier to infection. The remaining areas with adequate soft-tissue were covered with split-thickness skin graft. Cross-leg flap is well tolerated in paediatric cases and complications like joint movement limitation
Mehmet Subasi Tolga Tuzuner Department of Orthopaedics and Trauma Faculty of Medicine, Dicle University Diyarbakir, Turkey Corresponding author. Tel.: +90 412 2488111 fax: +90 412 2488111 E-mail address: [email protected] 4 August 2004 10.1016/j.injury.2004.08.002
LETTER TO THE EDITOR Dear editor I read with interest the paper–—‘Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles’ by Stefanolopoulos N et al.1 It is a worthwhile study on improvements to triage system. There are a few points to consider: 1. Unless it is a dead head-on collision, there is bound to be a rotational vector at the time of impact, which would put the vehicles in a position that would not immediately present as a head-on collision. This rotational force may cause secondary damage to the vehicles. Hence, it would not always be easy to assess whether the accident was a head-on collision when the paramedics arrive. 2. As discussed by the authors, the use of a seat belt in ‘compartment intruded’ (CI) vehicles affects hospitalisation of patients. From the information in Table 5, it can be seen that two-fifth FSO
Corresponding author. Tel.: +44 7786473361 E-mail addresses: [email protected] (Muhammad Shakil Akhtar) [email protected] (Munir Khan) [email protected] (Mohammad Waseem) 1 Tel.: +44 1625421000; Bleep:5073 2 Tel.: +44 1625824874 29 July 2004
233
are not seen. According to our unpublished data, we have obtained successful results in eight cases treated with early cross-leg flap. Our findings indicates that all early cross-leg flaps were successful and remained durable with no history of breakdown, and none of the children developed systemic complications or infection.
Reference
10.1016/j.injury.2004.07.030 1. Fujita M, Yokoyama K, Nakamura K, Uchino M, Wakita R, Itoman M. Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children. Injury 2004;35:272—7.
LETTER TO THE EDITOR Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children I read with interest the article in the March 2004 issue entitled ‘Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children’ by Fujita et al.1 The issue was evaluated very well, however I think that there is still need for additional knowledge about the cause of injuries and management of soft-tissue reconstruction. As the authors stated, The mechanism of the tibial fracture was presumed to be a direct hit sustained from the vehicle or tyre, and that of crushed foot structures was presumed to be torsional and compressive forces caused by tyres rolling over the feet. However, we have thought in our cases that tyres had caused deep injury including periost and cortex of the bone due to breaking effect of the vehicle while rolling over the feet. According to Gustillo classification, our patients with Type IIIB injury patients were immediately taken to the operating where all wounds were copiously irrigated and a more formal debridement was performed in the operating room. The ruptured extensor tendon was sutured to surrounding tissues in a neutral position. Parenteral antibiotic therapy, usually a cephalosporin administered for 7 days are used to counteract possible infection. Soft tissues of the crushed dorsal foot were managed cross-leg flaps. We think that cross-leg flap lead to less scaring with well excursion of the underlying tendons, and provide optimal coverage over exposed tendons and bones. Furthermore, early covering of open bone and tendons with cross-leg flap acts as an excellent biological dressing at the emergency stage, providing a further barrier to infection. The remaining areas with adequate soft-tissue were covered with split-thickness skin graft. Cross-leg flap is well tolerated in paediatric cases and complications like joint movement limitation
Mehmet Subasi Tolga Tuzuner Department of Orthopaedics and Trauma Faculty of Medicine, Dicle University Diyarbakir, Turkey Corresponding author. Tel.: +90 412 2488111 fax: +90 412 2488111 E-mail address: [email protected] 4 August 2004 10.1016/j.injury.2004.08.002
LETTER TO THE EDITOR Dear editor I read with interest the paper–—‘Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles’ by Stefanolopoulos N et al.1 It is a worthwhile study on improvements to triage system. There are a few points to consider: 1. Unless it is a dead head-on collision, there is bound to be a rotational vector at the time of impact, which would put the vehicles in a position that would not immediately present as a head-on collision. This rotational force may cause secondary damage to the vehicles. Hence, it would not always be easy to assess whether the accident was a head-on collision when the paramedics arrive. 2. As discussed by the authors, the use of a seat belt in ‘compartment intruded’ (CI) vehicles affects hospitalisation of patients. From the information in Table 5, it can be seen that two-fifth FSO