The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma

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dc.contributor.author Hohmann, Erik
dc.contributor.author Birkholtz, F.F. (Franz)
dc.contributor.author Glatt, Vaida
dc.contributor.author Tetsworth, Kevin
dc.date.accessioned 2017-08-01T07:26:30Z
dc.date.issued 2017-06
dc.description.abstract INTRODUCTION : The purpose of this study was to describe a standardized staged approach, “The Road to Union”, for the reconstruction of isolated complex tibial trauma, both acute and chronic in nature. METHODS : This retrospective study included all patients treated for complex tibial trauma at a specialized limb reconstruction centre, including acute open fracture as well as infected and aseptic non-unions. This standardized approach includes eight specific steps, employed in sequence. The time in external fixation (EFT), the external fixation index (EFI), and the distraction consolidation index (DCI) were the primary outcome measures. The relationship between EFI and DCI was assessed using Pearson’s moment correlations. RESULTS : Thirty-two patients with a mean age of 34.7 ± 14.2 years were included; 12 were treated for complex open tibial fractures with bone loss, 13 for infected non-unions, and 6 for aseptic non-union. The mean bone defect was 66 ± 32 mm. The total EFT was 42.5 ± 14.8 weeks; the EFI measured 51.9 ± 25.3 days/cm, and the DCI measured 48.3 ± 21.4 days/cm. Union was achieved in 29 out of 32 patients (91%), and there was a strong and significant relationship between EFI and DCI (r = 0.92, p = 0.0001) measurements. Pin site infections were observed in 11 patients, and 3 patients had persistent non-union. Three patients underwent delayed amputations when reconstructive procedures were unable to achieve union. CONCLUSION : The findings of this study demonstrate that a standardized staged treatment protocol of debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and functional rehabilitation can result in a high rate of union in cases of complex tibial trauma, both acute and chronic in nature. en_ZA
dc.description.department Orthopaedic Surgery en_ZA
dc.description.embargo 2018-06-30
dc.description.librarian hj2017 en_ZA
dc.description.uri https://www.journals.elsevier.com/injury/ en_ZA
dc.identifier.citation Hohmann, E., Birkholtz, F.F., Glatt, V. & Tetsworth, K. 2017, 'The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma', Injury, vol. 48, no. 6, pp. 1211-1216. en_ZA
dc.identifier.issn 1879-0267 (online)
dc.identifier.issn 0020-1383 (print)
dc.identifier.other 10.1016/j.injury.2017.03.018
dc.identifier.uri http://hdl.handle.net/2263/61535
dc.language.iso en en_ZA
dc.publisher Elsevier en_ZA
dc.rights © 2017 Elsevier Ltd. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Injury. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. A definitive version was subsequently published in Injury, vol. 48, no. 6, pp. 1211-1216, 2017. doi : 10.1016/j.injury.2017.03.018. en_ZA
dc.subject Time in external fixation (EFT) en_ZA
dc.subject External fixation index (EFI) en_ZA
dc.subject Tibial fractures en_ZA
dc.subject Complex trauma en_ZA
dc.subject Bone loss en_ZA
dc.subject Nonunion en_ZA
dc.subject Infection en_ZA
dc.subject Bone transport en_ZA
dc.subject Limb reconstruction en_ZA
dc.title The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma en_ZA
dc.type Postprint Article en_ZA


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