Orthoplastic management of severe open fractures: case report

Keywords: orthoplastic, orthoplastic approach, open fracture, Level of evidence: IV

Abstract

Open leg fractures are frequent injuries; the infection and difficulty in bone healing are their main complications.
The orthoplastic approach involves carrying out principles and practices of both specialties together, avoiding
separate treatment of the problems that arise from these serious injuries and thus minimizing complications. The objective of the article is to convey the importance of the orthoplastic approach in open fractures. We report the case of an adult patient, with an open fractured leg, to required multiple surgical procedures to preserve the limb.
Various strategies were necessary to cure the bone infection and reconstruct the soft tissue and bone. The limb function restore was possible promoting the ankle and foot mobility from the beginning and it allowed weightbearing on the limb through stable bone fixation, at 6 weeks of evolution.
We evidenced a patient and family satisfied with an excellent functional result according to the ASAMI score, at 24 moths of clinical and radiographic follow-up.
It is concluding that in patients with severe open fractures, the orthoplastic approach is key to obtain better
results. 

Downloads

Download data is not yet available.

References

Lua J, Tan VH, Sivasubramanian H, Kwek E. Complications of Open Tibial Fracture Management: Risk Factors and Treatment. Malays Orthop J. 2017;11(1):18-22.

Müller SLC, Morgenstern M, Kuehl R, Muri T, Kalbermatten DF, Clauss M, Schaefer DJ, Sendi P, Osinga R. Soft-tissue reconstruction in lower-leg fracture-related infections: An orthoplastic outcome and risk factor analysis.

Injury. 2021;52(11):3489-3497.

Fleming E, O’Daniel A, MD, Bharmal H, Valerio I; Application of the Orthoplastic Reconstructive Ladder to Preserve Lower Extremity Amputation Length. Ann Plast Surg. 2014;73:183-9

Mendenhall S, Ben-Amotz O, Gandhi R, Levin LS. A Review on the Orthoplastic Approach to Lower Limb Reconstruction. Indian J Plast Surg. 2019;52:17–25.

Yong-Cheol Y, Youngwoo K, Hyung KS, Young Hyun Y. Efficacy of Staged Surgery in the Treatment of Open Tibial Fractures with Severe Soft Tissue Injury and Bone Defect. Yonsei Med J. 2022;63(10):915-926.

Azoury SC, Stranix JT, Kovach SJ, Levin LS. Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?. JReconstr Microsurg. 2021;37(1):42-50.

D'Cunha EM, Penn-Barwell JG, McMaster J, Fries CA. Orthoplastic Treatment of Open Lower-Limb Fractures Improves Outcomes: A 12-Year Review. Plast Reconstr Surg. 2023;151(2):308e-314e.

Klifto KM, Azoury SC, Othman S, Klifto CS, Levin LS, Kovach SJ. The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis. Plast Reconstr Surg Glob

Open. 2021;9(3): e3494.

Choudry U, Moran S, Karacor Z. Soft-tissue coverage and outcome of gustilo grade IIIB midshaft tibia fractures: a 15-year experience. Plast Reconstr Surg. 2008;122(2):479-485.

Krishna A, Arora S, Goyal R, Kumar M, Naik N, Kumar M. Preventable iatrogenic cause of foot-drop in knee injuries with literature review. Chin J Traumatol. 2022;25(4):224–231. Published online 2021 Jul 14.

Solomin L, Slongo T. Long bone defect classification: what it should be? J Bone Res Rep Recommendations. 2016;2(1):2

Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;(241):146-65.

Sommar P, Granberg Y, Halle M, Skogh AC, Lundgren KT, Jansson KÅ. Effects of a formalized collaboration between plastic and orthopedic surgeons in severe extremity trauma patients; a retrospective study.J

Trauma Manag Outcomes. 2015; 9:3.

Boriani F, Ul Haq A, Baldini T, Urso R, Granchi D, Baldini N, Tigani D, Tarar M, Khan U. Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort

study. J Plast Reconstr Aesthet Surg. 2017;70(6):715-722.

Steinberger Z, Therattil PJ, Levin LS. Orthoplastic Approach to Lower Extremity Reconstruction: An Update. Clin Plast Surg. 2021;48(2):277-288.

Dieckmann R, Gebert C, Streitbürger A, Henrichs MP, Dirksen U, Rödl R, Gosheger G, Hardes J. Proximal fibula resection in the treatment of bone tumours Int Orthop. 2011;35(11):1689–1694.

Levin LS. The reconstructive ladder. An orthoplastic approach. Orthop Clin North Am. 1993;24(3):393–409.

Venkatramani H, Rodrigues JN, Sabapathy SR. Revisiting the reconstructive surgery framework: The reconstruction supermarket. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2019;72:529–531.

Beltrán L, Fraga Carvajal M, Cortabarría Izquierdo M, Graciano Balcón R. Colgajos locorregionales para defectos complejos de pierna y pie: uso actual en hospitales públicos de Montevideo, Uruguay. Cir. plást. iberolatinoam. 2020;46(2):197-206.

Toia F, Zabbia G, Scirpo R, Pirrello R, Nalbone L, Cordova. Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries.Handchir Mikrochir Plast Chir. 2019;51(6):484-491.

Published
2023-11-15
How to Cite
Filippini Irazun, J. P., De Arrascaeta, D., Cuesta, V., & Pascal, G. (2023). Orthoplastic management of severe open fractures: case report. Anales De La Facultad De Medicina, 10(2), e306. https://doi.org/10.25184/anfamed2023v10n2a10