On the treatment of tibial shaft fractures
Sammanfattning: The aim of this thesis was to evaluate those factors, which have predictive value for development of complications after tibial shaft fractures, and to evaluate the outcome of the available treatment methods for closed, as well as open tibial shaft fractures associated with extensive soft-tissue injury. To determine the factors, which influence healing speed, we reviewed 100 consecutive patients with 104 tibial shaft fractures tibial shaft fractures. The results showed that the relative risk of developing nonunion in open fractures was 8.2 and in fractures exposed to high-energy trauma was 2.9. We conducted a prospective study of 53 unilateral, displaced and closed or type I open tibial shaft fractures, who were randomized by technique of minimization in two treatment groups, 27 patients in the nailed group and 26 patients in the cast group. All patients were assessed for union, and complications were documented. All patients completed the Nottingham Health Profile questionnaire. They also assessed their pain intensity at rest and during walking on visual analogue scales. 27 of these patients entered into study III for assessment of the recovery of the injured limb. Using force platform and dynamometer, balance (as center of pressure) and muscle strength (as torque of the knee joint during knee extension) were measured, respectively. The results showed that treatment of displaced closed or type I open tibial fractures with intramedullary nailing is superior to cast/ brace treatment as regards early complication and recovery of limb function 1 year after healed fracture. A retrospective review of 18 consecutive patients with salvaged tibial shaft fractures associated with extensive soft-tissue damage was undertaken to evaluate bio-psycho-social function of the outcome. All patients were assessed for their physical function, psychological status and general function. The results demonstrated that the patients had obvious physical disability. However, non-depressive patients were generally satisfied with the outcome of salvage procedure. A retrospective review was conducted on consecutive 9 patients with tibial shaft fractures and extensive soft tissue damage, who had completed treatment by means of bone resection and distraction. All patients were treated by debridement of devitalized soft tissue and resection of dead bone at the fracture site. The median bone shortening was 4 (3-9) cm. There were no deep infections or nonunions and no secondary amputations. Bone debridement and limb lengthening, with multidisciplinary approach, is often successful in salvaging limbs that otherwise would have been at high risk for amputation.
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