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Clinical and radiological outcomes of gunshot-induced femur fractures: a comparative study of monolateral external fixators and hybrid advanced ilizarov method

Year 2023, , 678 - 683, 31.12.2023
https://doi.org/10.47582/jompac.1400344

Abstract

Aims: Clinical and radiological outcomes, complication rates, and 10-year follow-up results of comminuted femoral open fractures resulting from firearm injuries were evaluated by comparing the Hybrid Advanced Ilizarov method (HAIM) and monolateral external fixator (MEF) of the limb reconstruction system (LRS) for treatment.
Methods: Nineteen patients (18 males, 1 female) treated with HAIM and 14 male patients treated with MEF-LRS for femoral comminuted open fractures due to firearm injuries were retrospectively analyzed. Complication rates, pin tract and deep infection rates, time to union, and the need for secondary surgeries were assessed. The Tegner activity score and Short Form-36 (SF-36) were used for comparative evaluation of functional and radiological outcomes and comfort levels with the fixator.
Results: There were no significant differences between the groups in terms of age, gender, follow-up duration, time to union, union rate, delayed union, or deep infection. No infections were detected in either group that required a change in the fixation method. There were no significant differences in radiological and functional outcomes between the groups. Significant differences were observed in terms of pin tract infections between the groups. The comfort level of MEF-LRS patients was significantly higher than that of HAIM patients.
Conclusion: In the treatment of femoral fractures due to firearm injuries in early and long-term follow-ups, similar complication rates and functional outcomes were achieved for both MEF-LRS and HAIM methods. When considering external fixator preference, MEF-LRS is a better alternative, with a lower rate of pin tract infections and higher patient comfort level.

References

  • Polat G, Balci HI, Ergin ON, Asma A, Şen C, Kiliçoğlu Ö. A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries. Eur J Trauma Emerg Surg. 2018;44(3):451-455. doi: 10.1007/s00068-017-0814-6
  • Thoresby FP, Darlow HM. The mechanisms of primary infection of bullet wounds. Br J Surg. 1967;54(5):359-361.
  • Wolf AW, Benson DR, Shoji H, Hoeprich P, Gilmore A. Autosterilization in low-velocity bullets. J Trauma. 1978;18(1):63.
  • Klemn KW, Borner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;212:89-100.
  • Tornetta P 3rd, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma. 1995;38(2):213-219.
  • Lerner A, Fodor L, Soudry M. Is staged external fixation a valuable strategy for war injuries to the limbs. Clin Orthop Relat Res. 2006;448:217-224. doi: 10.1097/01.blo.0000214411.60722.f8
  • Paley D. Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop. 1990;250(1):81-104.
  • Inan M, Bomsr JD, Kucukkaya M, Harma A. A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies. Acta Orthop Traumatol Turc. 2004;38(4):252-260.
  • Thoresen BO, Alho A, Ekeland A, Strømsøe K, Follerås G, Haukebø A. Interlocking intramedullary nailing in femoral shaft fractures. a report of forty-eightcases. J Bone Joint Surg Am. 1985;67(9):1313-1320.
  • Davies MJ, Wells C, Squires PA, et al. Civilian firearm injury and death in England and Wales. Emerg Med J. 2012;29(1):10-14.
  • Arslan H, Kapukaya A, Necmioğlu NS. Treatment of subtrochanteric femoral fractures due to high-velocity gunshot injury. Acta Orthop Traumatol Turc. 1997;31(2):101-105.
  • Arslan H, Subasi M, Kesemenli C, Kapukaya A, Necmioglu S, Kayıkci C. Problem fractures assosiated with gunshot wounds in children. Injury. 2002;33(9):743-749
  • Necmioglu NS, Subası M, Kayıkcı C. Minimally invasive plate osteosynthesis in the treatment of femur fractures due to gunshot injuries. Acta Orthop Traumatol Turc. 2005;39(2):142-149
  • Atesalp AS, Kömürcü M, Demiralp B, Kürklü M, Tasatan E. Femur distal bölge eklem içi açık kırıklarının Ilizarov sirküler eksternal fiksatörü ile tedavisi. Gülhane Tıp Derg. 2005;47(2):89-93.
  • Gustilo RB, Merkow RB, Templeman D. Current concept review the management of open fractures. J Bone Joint Surgery. 1990;72(2):299-303.
  • Marsh JL, Jansen H, Yoong HK, Found EM. Supracondylar fracture of the femur treated by external fixation. J Orthop Trauma. 1997;11(6):405-411.
  • Inan M. Komplikasyonlar ve zorluklar. In: Çakmak M, Kocaoğlu M, editörler. Ilizarov Cerrahisi ve prensipleri. İstanbul: 1999: 237-254.
  • Green SA, Harris NL, Wall DM, Ishkanian J, Marinow H. The Rancho mounting technique for the Ilizarov method. a preliminary report. Clin Orthop. 1992;280:104-116.
  • Catagni MA, Malzev V, Kirienko A. Treatment of hip disorders. In: Maiocchi AB, editor. Advances in Ilizarov apparatus assembly. Milan: Il Quadratino: 1994:119-122.
  • Goldberg BA, Catagni MA. Hybrid advanced Ilizarov techniques: analgesia use and patient satisfaction. Am J Orthop. 2001;30(9):686-689.
  • Franke A, Bieler D, Wilms A, et al. Treatment of gunshot fractures of the lower extremity: part 1: incidence, importance, case numbers, pathophysiology, contamination, principles of emergency and first responder treatment. Der Unfallchirurg. 2014;117(11):975-976, 978-984. doi: 10.1007/s00113-014-2635-y
  • Paley D, Fleming B, Catagni M, Kristiansen T, Pope M. Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop. 1990;250:50-57.
  • Noonan KJ, Price CT, Sproul JT, Bright RW. Acute correction and distraction osteogenesis for the malaligned and shortened lower extremity. J Pediatr Orthop. 1998;18(2):178-186.

Ateşli silah kaynakli femur kiriklarinin klinik ve radyolojik sonuçlari: tek tarafli eksternal fiksatör ve geliştirilmiş hibrid Ilizarov yönteminin karşilaştirilmasi

Year 2023, , 678 - 683, 31.12.2023
https://doi.org/10.47582/jompac.1400344

Abstract

AMAÇ: Ateşli silah ile yaralanma (ASY) sonucu oluşan parçalı femur açık kırıklarının,
geliştirilmiş hibrid İlizarov yöntemi (GHİY) ve limb reconstruction system (LRS) tipi tek taraflı eksternal fiksatör (TEF) ile klinik ve radyolojik sonuçları, komplikasyon oranları ve 10 yıllık takip sonuçları karşılaştırılarak değerlendirildi.

YÖNTEM: ASY yaralanma sonucu oluşan femur parçalı açık kırık nedeniyle GHIY ile tedavi edilen 19 hasta (18 erkek, 1 kadın) ve LRS tipi TEF ile tedavi edilen 14 hasta (14 erkek) geriye dönük olarak incelendi. Komplikasyon oranları, pin dibi ve derin enfeksiyon oranları, kaynama zamanları, ikincil cerrahi gereksinimleri değerlendirildi. Tegner aktivite skoru ve kısa form-36 (SF-36) ile fonksiyonel ve radyolojik sonuçları, fiksatör ile konfor düzeyleri karşılaştırmalı olarak değerlendirildi.

BULGULAR: Gruplar arasında yaş, cinsiyet, takip süresi, kaynama zamanı, kaynama oranı, gecikmiş kaynama veya derin enfeksiyon açısından anlamlı fark yoktu. Her iki grupta da fiksasyon yöntemini değiştirecek bir enfeksiyon saptanmadı. Grupların radyolojik ve fonksiyonel sonuçlarla ilgili anlamlı farkları yoktu. Pin yolu enfeksiyonları açısından gruplar arasında önemli farklılıklar gözlendi. LRS tipi TEF hastalarının konfor seviyesi GHİY hastalarından anlamlı derecede yüksekti.

SONUÇLAR: Bu çalışmamızda, ASY`ye bağlı femur kırığı tedavisinde erken ve uzun dönem takiplerinde, hem LRS tipi TEF hem de GHİY yöntemi için benzer komplikasyon oranları ve fonksiyonel sonuçlar elde edildi. Eksternal fiksatör tercih edilmesi durumunda, LRS tipi TEF, düşük pin dibi enfeksiyonu oranı ve hasta için daha yüksek konfor seviyesi nedeniyle daha iyi bir alternatiftir.

References

  • Polat G, Balci HI, Ergin ON, Asma A, Şen C, Kiliçoğlu Ö. A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries. Eur J Trauma Emerg Surg. 2018;44(3):451-455. doi: 10.1007/s00068-017-0814-6
  • Thoresby FP, Darlow HM. The mechanisms of primary infection of bullet wounds. Br J Surg. 1967;54(5):359-361.
  • Wolf AW, Benson DR, Shoji H, Hoeprich P, Gilmore A. Autosterilization in low-velocity bullets. J Trauma. 1978;18(1):63.
  • Klemn KW, Borner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;212:89-100.
  • Tornetta P 3rd, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma. 1995;38(2):213-219.
  • Lerner A, Fodor L, Soudry M. Is staged external fixation a valuable strategy for war injuries to the limbs. Clin Orthop Relat Res. 2006;448:217-224. doi: 10.1097/01.blo.0000214411.60722.f8
  • Paley D. Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop. 1990;250(1):81-104.
  • Inan M, Bomsr JD, Kucukkaya M, Harma A. A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies. Acta Orthop Traumatol Turc. 2004;38(4):252-260.
  • Thoresen BO, Alho A, Ekeland A, Strømsøe K, Follerås G, Haukebø A. Interlocking intramedullary nailing in femoral shaft fractures. a report of forty-eightcases. J Bone Joint Surg Am. 1985;67(9):1313-1320.
  • Davies MJ, Wells C, Squires PA, et al. Civilian firearm injury and death in England and Wales. Emerg Med J. 2012;29(1):10-14.
  • Arslan H, Kapukaya A, Necmioğlu NS. Treatment of subtrochanteric femoral fractures due to high-velocity gunshot injury. Acta Orthop Traumatol Turc. 1997;31(2):101-105.
  • Arslan H, Subasi M, Kesemenli C, Kapukaya A, Necmioglu S, Kayıkci C. Problem fractures assosiated with gunshot wounds in children. Injury. 2002;33(9):743-749
  • Necmioglu NS, Subası M, Kayıkcı C. Minimally invasive plate osteosynthesis in the treatment of femur fractures due to gunshot injuries. Acta Orthop Traumatol Turc. 2005;39(2):142-149
  • Atesalp AS, Kömürcü M, Demiralp B, Kürklü M, Tasatan E. Femur distal bölge eklem içi açık kırıklarının Ilizarov sirküler eksternal fiksatörü ile tedavisi. Gülhane Tıp Derg. 2005;47(2):89-93.
  • Gustilo RB, Merkow RB, Templeman D. Current concept review the management of open fractures. J Bone Joint Surgery. 1990;72(2):299-303.
  • Marsh JL, Jansen H, Yoong HK, Found EM. Supracondylar fracture of the femur treated by external fixation. J Orthop Trauma. 1997;11(6):405-411.
  • Inan M. Komplikasyonlar ve zorluklar. In: Çakmak M, Kocaoğlu M, editörler. Ilizarov Cerrahisi ve prensipleri. İstanbul: 1999: 237-254.
  • Green SA, Harris NL, Wall DM, Ishkanian J, Marinow H. The Rancho mounting technique for the Ilizarov method. a preliminary report. Clin Orthop. 1992;280:104-116.
  • Catagni MA, Malzev V, Kirienko A. Treatment of hip disorders. In: Maiocchi AB, editor. Advances in Ilizarov apparatus assembly. Milan: Il Quadratino: 1994:119-122.
  • Goldberg BA, Catagni MA. Hybrid advanced Ilizarov techniques: analgesia use and patient satisfaction. Am J Orthop. 2001;30(9):686-689.
  • Franke A, Bieler D, Wilms A, et al. Treatment of gunshot fractures of the lower extremity: part 1: incidence, importance, case numbers, pathophysiology, contamination, principles of emergency and first responder treatment. Der Unfallchirurg. 2014;117(11):975-976, 978-984. doi: 10.1007/s00113-014-2635-y
  • Paley D, Fleming B, Catagni M, Kristiansen T, Pope M. Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop. 1990;250:50-57.
  • Noonan KJ, Price CT, Sproul JT, Bright RW. Acute correction and distraction osteogenesis for the malaligned and shortened lower extremity. J Pediatr Orthop. 1998;18(2):178-186.
There are 23 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Cem Sever 0000-0002-3119-1327

Mesut Karıksız 0000-0002-9632-7694

Publication Date December 31, 2023
Submission Date December 4, 2023
Acceptance Date December 21, 2023
Published in Issue Year 2023

Cite

AMA Sever C, Karıksız M. Clinical and radiological outcomes of gunshot-induced femur fractures: a comparative study of monolateral external fixators and hybrid advanced ilizarov method. J Med Palliat Care / JOMPAC / Jompac. December 2023;4(6):678-683. doi:10.47582/jompac.1400344

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