Journal of Musculoskeletal Trauma

Treatment of Type IIIb Open Tibial Fractures: Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song; J Korean Fract Soc 2014;27(4):267-273. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.267

PURPOSE
The purpose of this study is to evaluate the outcome of treatment for patients with Type IIIb open tibial fractures.
MATERIALS AND METHODS
This study targeted 35 adult patients for whom follow-up was possible over one year after undergoing surgical treatment. There were 29 males and six females with an average age of 45 years.
RESULTS
Fracture location was proximal in 10 cases, midshaft in 13 cases, and the distal part of the tibia in 12 cases. An average of 10 days was observed for definitive fixation with soft tissue coverage of the injury. The mean time to radiographic union was 27 weeks. Sixteen cases (45.7%) of complications were observed. Three cases of superficial infection, two cases of deep infection, four cases of partial flap necrosis, three cases of mal-alignment, three cases of joint stiffness, and one case of hardware breakage were observed. The mean lower extremity functional scale score was 68.5 and the factors influencing the clinical results were severity of open wound (p=0.000) and occurrence of complications (p=0.000) according to results of multiple regression analysis.
CONCLUSION
In treatment of Type IIIb open tibial fractures, good clinical results can be expected provided that complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation.

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Effect of Korean Medicine Treatments in Patients with Proximal Tibia Fracture: A Retrospective Observational Study
Jung Min Lee, Eun-Jung Lee
Journal of Korean Medicine Rehabilitation.2020; 30(3): 141. CrossRef

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Treatment of Open Tibial Shaft Fractures using Unreamed Nailing: Jong Keon Oh, Chang Wug Oh, Kwon Jae Roh, Duk Moon Chung; J Korean Fract Soc 2005;18(1):22-28. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.22

Abstract PDF

PURPOSE
To report the results of unreamed nailing using a nail with the largest possible diameter for the management of the open tibial shaft fractures.
MATERIALS AND METHODS
Nineteen patients with open tibial shaft fractures underwent unreamed nailing with the largest possible diameter according to the isthmic diameter measured on preoperative radiography. There were 1 Grade I, 6 Grade II, 9 Grade IIIa, 3 Grade IIIb open fractures. There were 4 type A, 12 type B, 3 type C fractures according to the OTA classification. Fractures were classified as The nail was introduced after gentle passage of a 7 to 8 millimeter-hand reamer.
RESULTS
Union was obtained in all cases. However 9 (47%) fractures required an additional procedures before union. In 6 cases, dynamization was done. Two of them were required exchange nailing for nonunion, 1 of two gained bony union through additional bone graft. Three of the others had gained union through exchange nailing, bone graft, bone transport respectively. There were one rotational malunion, one superfical and one deep infection. Interlocking screw breakage developed only in one patient.
CONCLUSION
Our data indicate that unreamed nailing in the management of open tibial fractures is safe and reliable method. Using a tight fitting nail with the largest possible diameter is a safe and effective way to avoid the problems of screw breakage.

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Treatment of Type IIIb Open Tibial Fractures
Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song
Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation
Yerl-Bo Sung
Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef

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Disseminated Intravascular Coagulation Following Septic Shock in Multiple Open Fractures : a Case Report: Tai Seung Kim, Jae Lim Cho, Choong Hyeok Choi, Sung Hee Oh, Do Hyeung Kim, Kuhn Sung Whang; J Korean Soc Fract 1997;10(3):583-587. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.583

Abstract PDF: Disseminated intravascular coagulation is known to be a syndrome which can evoke compound derangement in the cascade mechanism of normal hemostasis, which causes depletion of coagulation factors, secondary fibrinolysis, and eventually massive and uncontrollable bleeding. Even though there still are not absolute criteria for diagnosis, some laboratory findings - platelet count, plasma fibrinogen, fibrinogen degradation product, plasma protamine test, etc - can suggest the possibility to diaglose. The basic principle in management is to eliminate the triggering mechanism as soon as possible and to cure the initial disease entities. In orthopedic point of view, disseminated intravascular coagulation can occur in the case of malignancy, massive trauma, infection, sepsis and so on. Authors report a case of disseminated intravascular coagulation occured in a 12 year 2 month old male patient who visited Hanyang university hospital in septic condition after emergency operations following multiple open fractures on his left femur. tibia and fibula in a motor-cycle accident.

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A Clinical Study of rmmediate Internal Fixation(within 24 Hrs) in Open Fractures of The Long Bones: Yoon Sik Kim, Jae Eung Yoo, Chi Soo Sohn, Jong Seouk Park, Hee Kwon, Joon Min Song, Soo Kyun Rah; J Korean Soc Fract 1996;9(3):593-604. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.593

Abstract PDF: The major goals in the treatment of open fractures of the long bones are to prevent infection, avoid malunion or nonunion, achieve bone union, and restore limb and patient function as soon and as fully as possible. The treatment modalities adopted in open fractures still remains controversial, especially in Gustilo-Anderson Type III. It has been the fear of infection that has lead to the traditionally accepted opinion that immediate internal fixation of open fractures is contraindicated but, nowadays, it is no longer tabooed. Owing to the early meticulous wound debridment and irrigation, and the use of bactericidal antibiotics, the infection rate reduced remarkably. Fifty-five cases of open long bone fractures treated by immediate internal fixation within 24 hours from inury were reviewed, which were treated at the Department of Orthopedic Surgery, Soonchunhyang University hospital for nine and half years from June, 1985 to January, 1995. The results were as follow: 1, There were 20 Type II , 19 Type III A, 10 Type IIIB and 5 Type IIIC open fractures treated by immediate internal fixation within 24 hours following to Gustilo-Andersons classification. 2. The most common causes of open fractures were traffic accident(84%). 3. The associated injuries of the patients treated by immediate infernal fixation were in sequence.:26 multitraumatized patient, 5 arterial injuries, 5 musculotendinous injuries, 3 major joint dislocations and so forth. 4. Normal bony union was achieved in 41 patients(73.2%), Delayed bony union was in 7 patient(12.5%) and nonunion in 8 patients(14.5%). 5. Primary wound healing was achieved in 40 patients(71.4%), superficial to moderate infection were in 5 patients(9%), deep to osteomyelitis in 11 patients(19.6%). 6. According to the subtypes of open fractures, deep to osteomyelitis were 80% in Type IIIC, 30% in Type IIIB, 10.6% in Type IIIA and 10% in Type II.

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