Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature

Overview

Journal Strategies Trauma Limb Reconstr

Date 2022 Jun 23

PMID 35734040

Authors

Konstantins Plotnikovs

Jevgenijs Movcans

Leonid Solomin

Affiliations

Soon will be listed here.

Abstract

Introduction: The presence of massive soft tissue loss in open tibial fractures is a challenging problem. Acute limb shortening is an alternative solution in situations where the use of flaps is limited.

Materials And Methods: A review was conducted following the Preferred Reported Items for Systematic Reviews and Meta-analyses checklist (PRISMA) guidelines. A complete search of PubMed, EMBASE and MEDLINE was undertaken. Twenty-four articles related to closure of soft tissue defects through acute limb shortening were identified and included in this review.

Results: All report on restoration of limb function without or with minimal residual shortening. The authors note a decrease in the need for microsurgery. The external fixation devices used for deformity correction after closure of the soft tissue defect by acute shortening, angulation and rotation were the Ilizarov apparatus and circular fixator hexapods mainly.

Conclusion: Acute shortening is an alternative to microsurgical techniques. A ring external fixator is useful for restoring limb alignment after closing the soft tissue defect through creating a temporary deformity. The use of circular fixator hexapods can enable accurate correction of complex multicomponent deformities without the need to reassembly of individual correction units.

How To Cite This Article: Plotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022;17(1):44-54.

Citing Articles

Tibial periosteum flap combined with autologous bone grafting in the treatment of Gustilo-IIIB/IIIC open tibial fractures.

Gao Y, Liu Y, Hu H, Gao S, Zhou J Open Med (Wars). 2024; 19(1):20241038.

PMID: 39308921 PMC: 11416071. DOI: 10.1515/med-2024-1038.

Artificial Deformity Creation as a Method for Limb Salvage for Patients with Massive Tibial and Soft Tissue Defects: A Report of 26 Cases.

Plotnikovs K, Kamenska J, Movcans J, Pasters V, Solomin L, Plaudis H Strategies Trauma Limb Reconstr. 2024; 18(3):133-139.

PMID: 38404570 PMC: 10891353. DOI: 10.5005/jp-journals-10080-1599.

Acute shortening and angulation for complex open fractures: an updated perspective.

Pierrie S, Beltran M OTA Int. 2023; 6(4 Suppl):e245.

PMID: 37448568 PMC: 10337845. DOI: 10.1097/OI9.0000000000000245.

Current Concepts of Fracture-Related Infection.

He S, Yu B, Jiang N Int J Clin Pract. 2023; 2023:4839701.

PMID: 37153693 PMC: 10154639. DOI: 10.1155/2023/4839701.

References

Beltran M, Ochoa L, Graves R, Hsu J . Composite bone and soft tissue loss treated with distraction histiogenesis. J Surg Orthop Adv. 2010; 19(1):23-8. View

Parmaksizoglu F, Koprulu A, Unal M, Cansu E . Early or delayed limb lengthening after acute shortening in the treatment of traumatic below-knee amputations and Gustilo and Anderson type IIIC open tibial fractures: The results of a case series. J Bone Joint Surg Br. 2010; 92(11):1563-7. DOI: 10.1302/0301-620X.92B11.23500. View

Atbasi Z, Demiralp B, Kilic E, Kose O, Kurklu M, Basbozkurt M . Angiographic evaluation of arterial configuration after acute tibial shortening. Eur J Orthop Surg Traumatol. 2013; 24(8):1587-95. DOI: 10.1007/s00590-013-1327-6. View

Court-Brown C, Rimmer S, Prakash U, McQueen M . The epidemiology of open long bone fractures. Injury. 1999; 29(7):529-34. DOI: 10.1016/s0020-1383(98)00125-9. View

Hsu J, Beltran M . Shortening and angulation for soft-tissue reconstruction of extremity wounds in a combat support hospital. Mil Med. 2009; 174(8):838-42. View

Eren I, Eralp L, Kocaoglu M . Comparative clinical study on deformity correction accuracy of different external fixators. Int Orthop. 2013; 37(11):2247-52. PMC: 3824895. DOI: 10.1007/s00264-013-2116-x. View

Pierrie S, Hsu J . Shortening and Angulation Strategies to Address Composite Bone and Soft Tissue Defects. J Orthop Trauma. 2017; 31 Suppl 5:S32-S35. DOI: 10.1097/BOT.0000000000000976. View

Pikkel Y, Wilson J, Kassis S, Lerner A . Acute shortening and angulation for limb salvage in a paediatric patient with a high-energy blast injury. BMJ Case Rep. 2014; 2014. PMC: 3962977. DOI: 10.1136/bcr-2013-203431. View

Manner H, Huebl M, Radler C, Ganger R, Petje G, Grill F . Accuracy of complex lower-limb deformity correction with external fixation: a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop. 2009; 1(1):55-61. PMC: 2656701. DOI: 10.1007/s11832-006-0005-1. View

10.

Giebel G . [Resection debridement of the lower leg with compensatory callus distraction]. Unfallchirurg. 1991; 94(8):401-8. View

11.

Lerner A, Fodor L, Soudry M, Peled I, Herer D, Ullmann Y . Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities. J Trauma. 2004; 57(3):603-8. DOI: 10.1097/01.ta.0000087888.01738.35. View

12.

Papakostidis C, Kanakaris N, Pretel J, Faour O, Morell D, Giannoudis P . Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury. 2011; 42(12):1408-15. DOI: 10.1016/j.injury.2011.10.015. View

13.

Betz A, Stock W, Hierner R, Baumgart R . Primary shortening with secondary limb lengthening in severe injuries of the lower leg: a six year experience. Microsurgery. 1993; 14(7):446-53. DOI: 10.1002/micr.1920140706. View

14.

Sharma H, Nunn T . Conversion of open tibial IIIb to IIIa fractures using intentional temporary deformation and the Taylor Spatial Frame. Strategies Trauma Limb Reconstr. 2013; 8(2):133-40. PMC: 3732672. DOI: 10.1007/s11751-013-0160-0. View

15.

Weber C, Hildebrand F, Kobbe P, Lefering R, Sellei R, Pape H . Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications. Eur J Trauma Emerg Surg. 2018; 45(3):445-453. DOI: 10.1007/s00068-018-0916-9. View

16.

Bundgaard K, Christensen K . Tibial bone loss and soft-tissue defect treated simultaneously with llizarov-technique--a case report. Acta Orthop Scand. 2001; 71(5):534-6. DOI: 10.1080/000164700317381306 . View

17.

Lerner A, Fodor L, Stein H, Soudry M, Peled I, Ullmann Y . Extreme bone lengthening using distraction osteogenesis after trauma: a case report. J Orthop Trauma. 2005; 19(6):420-4. DOI: 10.1097/01.bot.0000177388.05060.a4. View

18.

Demir B, Gursu S, Oke R, Konya N, Ozturk K, Sahin V . Shortening and secondary relengthening for chronically infected tibial pseudarthroses with poor soft tissues. J Orthop Sci. 2009; 14(5):525-34. DOI: 10.1007/s00776-009-1364-5. View

19.

El-Rosasy M . Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia. J Bone Joint Surg Br. 2007; 89(1):80-8. DOI: 10.1302/0301-620X.89B1.17595. View

20.

Paley D, Maar D . Ilizarov bone transport treatment for tibial defects. J Orthop Trauma. 2000; 14(2):76-85. DOI: 10.1097/00005131-200002000-00002. View