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Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

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Chinese Journal of Traumatology 2019年第3期22卷 166-171页

作者： Koushik Narayan Subramanyam Madhusudhan Tammanaiah abhishek vasant mundargi Ritesh Nilakanthrao Bhoskar Patllola Siddharth Reddy Department of Orthopaedics Sri Sathya Sai Institute of Higher Medical SciencesPrashanthigramPuttaparthiAndhra Pradesh 515134India

Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures;15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion: Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.

关键词： Tibial plateau fractures Schatzker's classification Ilizarov techniques Ring fixator

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Surgical management of chronic osteomyelitis:Organisms,recurrence and treatment outcome

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Chinese Journal of Traumatology 2023年第4期26卷 228-235页

作者： Koushik Narayan Subramanyam abhishek vasant mundargi Milind Vittal Prabhu K.U.Gopakumar D.S.Ankush Gowd Devagiri Raviteja Reddy Department of Orthopaedics Sri Sathya Sai Institute of Higher Medical Sciences-PrasanthigramPuttaparthiAndhra Pradesh515134India School of Liberal Arts Indian Institute of TechnologyJodhpurRajasthan342001India

Purpose:The study aimed to identify the risk factors of recurrence in chronic osteomyelitis(COM)and to document the microbiological patterns pre-and intra-operatively and at recurrence,if ***:We performed retrospective review on COM patients treated with surgical debridement and a 6-week course of *** patients with symptoms of osteomyelitis for at least 6 weeks,present or past episodes of discharging sinus,documentation of bone sequestration in operative notes or preop-erative images were included in the *** with symptoms of osteomyelitis<6 weeks,lack of history of discharging sinus or lack of evidence of sequestration in preoperative images or intraoperative notes were *** regression models were used to assess the impact of risk factors of ***-Kappa scores were derived to see the concordance between pre-operative and intra-operative isolates and at ***:Totally,147 COM patients(115 males and 32 females,mean age(33±19)years)were included in this *** was noted in 28 patients(19.0%).Polymicrobial growth and extended spectrum beta-lactamase producing Enterobacteriaceae increased the chance of ***-Mader stage-1,hematogenous aetiology and negative intraoperative culture reduced the chance of *** between pre-operative and intra-operative cultures was 59.85%(Kappa score 0.526,p<0.001)and between index surgery and at recurrence was 23.81%(Kappa score 0.155,p<0.001).Lack of knowledge of causative organism preoperatively did not affect *** mean follow-up(42±15)months,all patients were apparently infection free for at least 1 ***:Polymicrobial growth and multi-drug resistant organisms increase the risk of recurrence in ***'age,gender,diabetes mellitus,previous failed treatment,duration of symptoms,hae-moglobin,white cell count,C-reactive protein and erythrocyte sedimentation rate at presentation did not have any impact on the recurre

关键词： Chronic osteomyelitis Debridement Antibiotics Osteomyelitis recurrence Osteomyelitis relapse

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