Application of antibiotic bone cement-coated plates internal fixation for primary treating Gustilo type <b>Ⅲ</b>B tibiofibular open fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

KANG Yongqiang ¹ , WU Yongwei ¹ ^△ ,  RUI Yongjun ¹ , ZHANG Qingqing ² , MA Yunhong ¹ , JIA Xueyuan ¹ , ZHANG Mingyu ¹ , ZHOU Ming ¹ , LIN Fang ¹ , KANG Yongqiang ¹ , WU Yongwei ¹ ^△ ,  RUI Yongjun ¹ , ZHANG Qingqing ² , MA Yunhong ¹ , JIA Xueyuan ¹ , ZHANG Mingyu ¹ , ZHOU Ming ¹ , LIN Fang ¹

1. Department of Trauma Orthopedics, Wuxi Ninth People’s Hospital, Wuxi Jiangsu, 214062, P. R. China;
2. Department of Record Room, Wuxi Ninth People’s Hospital, Wuxi Jiangsu, 214062, P. R. China;

Corresponding author：

RUI Yongjun, Email: wxswkryj123@126.com; RUI Yongjun, Email: wxswkryj123@126.com

Keywords：

Tibiofibular open fractures; bone transplantation; internal fixation; antibiotic bone cement

DOI：

10.7507/1002-1892.202401099

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Objective To explore the effectiveness of using antibiotic bone cement-coated plates internal fixation technology as a primary treatment for Gustilo type ⅢB tibiofibular open fractures. Methods The clinical data of 24 patients with Gustilo type ⅢB tibiofibular open fractures who were admitted between January 2018 and December 2021 and met the selection criteria was retrospectively analyzed. Among them, there were 18 males and 6 females, aged from 25 to 65 years with an average age of 45.8 years. There were 3 cases of proximal tibial fracture, 6 cases of middle tibial fracture, 15 cases of distal tibial fracture, and 21 cases of fibular fracture. The time from injury to emergency surgery ranged from 3 to 12 hours, with an average of 5.3 hours. All patients had soft tissue defects ranging from 10 cm×5 cm to 32 cm×15 cm. The time from injury to skin flap transplantation for wound coverage ranged from 1 to 7 days, with an average of 4.1 days, and the size of skin flap ranged from 10 cm×5 cm to 33 cm×15 cm. Ten patients had bone defects with length of 2-12 cm (mean, 7.1 cm). After emergency debridement, the tibial fracture end was fixed with antibiotic bone cement-coated plates, and the bone defect area was filled with antibiotic bone cement. Within 7 days, the wound was covered with a free flap, and the bone cement was replaced while performing definitive internal fixation of the fracture. In 10 patients with bone defect, all the bone cement was removed and the bone defect area was grafted after 7-32 weeks (mean, 11.8 weeks). The flap survival, wound healing of the affected limb, complications, and bone healing were observed after operation, and the quality of life was evaluated according to the short-form 36 health survey scale (SF-36 scale) [including physical component summary (PCS) and mental component summary (MCS) scores] at 1 month, 6 months after operation, and at last follow-up. Results All 24 patients were followed up 14-38 months (mean, 21.6 months). All the affected limbs were successfully salvaged and all the transplanted flaps survived. One case had scar hyperplasia in the flap donor site, and 1 case had hypoesthesia (grade S3) of the skin around the scar. There were 2 cases of infection in the recipient area of the leg, one of which was superficial infection after primary flap transplantation and healed after debridement, and the other was sinus formation after secondary bone grafting and was debrided again 3 months later and treated with Ilizarov osteotomy, and healed 8 months later. The bone healing time of the remaining 23 patients ranged from 4 to 9 months, with an average of 6.1 months. The scores of PCS were 44.4±6.5, 68.3±8.3, 80.4±6.9, and the scores of MCS were 59.2±8.2, 79.5±7.8, 90.0±6.6 at 1 month, 6 months after operation, and at last follow-up, respectively. The differences were significant between different time points (P<0.05). Conclusion Antibiotic bone cement-coated plates internal fixation can be used in the primary treatment of Gustilo type ⅢB tibiofibular open fractures, and has the advantages of reduce the risk of infection in fracture fixation, reducing complications, and accelerating the functional recovery of patients.

Citation： KANG Yongqiang, WU Yongwei, RUI Yongjun, ZHANG Qingqing, MA Yunhong, JIA Xueyuan, ZHANG Mingyu, ZHOU Ming, LIN Fang. Application of antibiotic bone cement-coated plates internal fixation for primary treating Gustilo type ⅢB tibiofibular open fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 426-431. doi: 10.7507/1002-1892.202401099 Copy

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38.	Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
39.	Kang Y, Wu Y, Ma Y, et al. “Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation. Injury, 2020, 51(12): 2970-2974.
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1. Schenker ML, Yannascoli S, Baldwin KD, et al. Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg (Am), 2012, 94(12): 1057-1064.
2. Schenker ML, Yannascoli S, Baldwin KD, et al. Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg (Am), 2012, 94(12): 1057-1064.
3. 李迦宇, 周鑫, 唐林, 等. 锁定加压钢板外置结合下腹壁联体皮瓣治疗胫骨开放性骨折合并软组织缺损. 中华显微外科杂志, 2022, 45(3): 293-297.
4. 李迦宇, 周鑫, 唐林, 等. 锁定加压钢板外置结合下腹壁联体皮瓣治疗胫骨开放性骨折合并软组织缺损. 中华显微外科杂志, 2022, 45(3): 293-297.
5. 王祥, 李青松, 梁伟, 等. 一期骨短缩吻合血管结合二期骨延长治疗小腿GustiloⅢC型骨折八例. 中华显微外科杂志, 2021, 44(6): 663-667.
6. 王祥, 李青松, 梁伟, 等. 一期骨短缩吻合血管结合二期骨延长治疗小腿GustiloⅢC型骨折八例. 中华显微外科杂志, 2021, 44(6): 663-667.
7. Al-Hourani K, Pearce O, Kelly M. Standards of open lower limb fracture care in the United Kingdom. Injury, 2021, 52(3): 378-383.
8. Al-Hourani K, Pearce O, Kelly M. Standards of open lower limb fracture care in the United Kingdom. Injury, 2021, 52(3): 378-383.
9. Hatashita S, Kawakami R, Ejiri S, et al. ‘Acute Masquelet technique’ for reconstructing bone defects of an open lower limb fracture. Eur J Trauma Emerg Surg, 2021, 47(4): 1153-1162.
10. Hatashita S, Kawakami R, Ejiri S, et al. ‘Acute Masquelet technique’ for reconstructing bone defects of an open lower limb fracture. Eur J Trauma Emerg Surg, 2021, 47(4): 1153-1162.
11. 庞哲栋, 肖连根, 樊光亚, 等. 抗生素骨水泥治疗慢性创面的研究进展. 中国现代医生, 2023, 61(11): 120-124.
12. 庞哲栋, 肖连根, 樊光亚, 等. 抗生素骨水泥治疗慢性创面的研究进展. 中国现代医生, 2023, 61(11): 120-124.
13. Wang X, Wang S, Fu J, et al. Risk factors associated with recurrence of extremity osteomyelitis treated with the induced membrane technique. Injury, 2020, 51(2): 307-311.
14. Wang X, Wang S, Fu J, et al. Risk factors associated with recurrence of extremity osteomyelitis treated with the induced membrane technique. Injury, 2020, 51(2): 307-311.
15. Scolaro JA, Mehta S. Stabilisation of infected peri-articular nonunions with an antibiotic impregnated cement coated locking plate: Technique and indications. Injury, 2016, 47(6): 1353-1356.
16. Scolaro JA, Mehta S. Stabilisation of infected peri-articular nonunions with an antibiotic impregnated cement coated locking plate: Technique and indications. Injury, 2016, 47(6): 1353-1356.
17. 中华医学会骨科学分会, 沈杰, 陈林, 等. 膜诱导技术治疗感染性骨缺损临床循证指南(2023版). 中华创伤杂志, 2023, 39(2): 107-120.
18. 中华医学会骨科学分会, 沈杰, 陈林, 等. 膜诱导技术治疗感染性骨缺损临床循证指南(2023版). 中华创伤杂志, 2023, 39(2): 107-120.
19. 康永强, 芮永军, 吴永伟, 等. 3D打印量化植骨辅助Masquelet技术二阶段治疗GustiloⅢB、ⅢC型胫腓骨骨折长段骨缺损的疗效. 中华创伤杂志, 2023, 39(3): 252-258.
20. 康永强, 芮永军, 吴永伟, 等. 3D打印量化植骨辅助Masquelet技术二阶段治疗GustiloⅢB、ⅢC型胫腓骨骨折长段骨缺损的疗效. 中华创伤杂志, 2023, 39(3): 252-258.
21. Wang P, Wu Y, Rui Y, et al. Masquelet technique for reconstructing bone defects in open lower limb fracture: Analysis of the relationship between bone defect and bone graft. Injury, 2021, 52(4): 988-995.
22. Wang P, Wu Y, Rui Y, et al. Masquelet technique for reconstructing bone defects in open lower limb fracture: Analysis of the relationship between bone defect and bone graft. Injury, 2021, 52(4): 988-995.
23. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg (Br), 1995, 77B: 417-421.
24. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg (Br), 1995, 77B: 417-421.
25. 詹晓欢, 陈元荣, 罗桦杰, 等. GustiloⅢB和ⅢC型骨折治疗进展. 中华显微外科杂志, 2018, 41(3): 310-312, 后插1.
26. 詹晓欢, 陈元荣, 罗桦杰, 等. GustiloⅢB和ⅢC型骨折治疗进展. 中华显微外科杂志, 2018, 41(3): 310-312, 后插1.
27. Zhu YL, Guo BF, Zang JC, et al. Ilizarov technology in China: a historic review of thirty-one years. Int Orthop, 2022, 46(3): 661-668.
28. Zhu YL, Guo BF, Zang JC, et al. Ilizarov technology in China: a historic review of thirty-one years. Int Orthop, 2022, 46(3): 661-668.
29. 秦泗河, 郭保逢, 杜辉. 基于Ilizarov技术的小腿延长术. 中华骨科杂志, 2021, 41(11): 720-727.
30. 秦泗河, 郭保逢, 杜辉. 基于Ilizarov技术的小腿延长术. 中华骨科杂志, 2021, 41(11): 720-727.
31. Diwan A, Eberlin KR, Smith RM. The principles and practice of open fracture care, 2018. Chin J Traumatol, 2018, 21(4): 187-192.
32. Diwan A, Eberlin KR, Smith RM. The principles and practice of open fracture care, 2018. Chin J Traumatol, 2018, 21(4): 187-192.
33. Winstanley RJH, Hadfield JN, Walker R, et al. The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK. Bone Joint J, 2022, 104-B(9): 1073-1080.
34. Winstanley RJH, Hadfield JN, Walker R, et al. The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK. Bone Joint J, 2022, 104-B(9): 1073-1080.
35. Schmidmaier G, Lucke M, Wildemann B, et al. Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review. Injury, 2006, 37 Suppl 2: S105-S112.
36. Schmidmaier G, Lucke M, Wildemann B, et al. Prophylaxis and treatment of implant-related infections by antibiotic-coated implants: a review. Injury, 2006, 37 Suppl 2: S105-S112.
37. Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
38. Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
39. Kang Y, Wu Y, Ma Y, et al. “Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation. Injury, 2020, 51(12): 2970-2974.
40. Kang Y, Wu Y, Ma Y, et al. “Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation. Injury, 2020, 51(12): 2970-2974.
41. Costa ML, Achten J, Bruce J, et al. Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: The WOLLF randomized clinical trial. JAMA, 2018, 319(22): 2280-2288.
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43. 纪振钢, 周大鹏, 韩天宇, 等. Masquelet膜诱导技术治疗创伤性长骨骨缺损的效果. 中华创伤杂志, 2019, 35(2): 128-135.
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Chinese Journal of Reparative and Reconstructive Surgery

Application of antibiotic bone cement-coated plates internal fixation for primary treating Gustilo type ⅢB tibiofibular open fracture

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