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《Chinese Journal of Critical Care Medicine》 2008-01
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Staged management in patients with high-energy extremities fractures

TAO Jie,CAO Yun,WANG Qiu -gen,et al. Orthopedics Department,Shanghai First People's Hospital,College of Medicine,Shanghai Jiao Tong University,Shanghai 201620,China Corresponding auther:WANG Qiu-gen,Email:wangqiugen@126.com  
Objective To explore the strategies of staged management in patients with high-energy extremities fractures. Methods Twenty-nine patients with high-energy fractures were managed from Feb 2004 to Mar 2007. All patients were operated with external fixations of singlearm external fixator (Orthofix) or Hoffmann external fixator (Stryker) in the very early stage. After well controlled the general conditions and reepithelialization of skin injury,transferred to strong internal fixations through open reduction or close reduction with the technique of Minimally Invasive Percutaneous Plate Oesteosynthesis (MIPPO). Results External fixations were initially used for 29 high-energy fractures,and the mean interval was 13.2 days(range 7 to 49 days),then transferred to internal fixations. No case of compartment syndrome occurred in this study. But one case of open Pilon fracture suffered with infection after external fixation,and 7 weeks later he was transferred to internal plate fixation locally treated together with Gentamycin-released beads. The infection was controlled and also the bone reunited. Conclusions Proper staged management,right timing of fixation changing and well protecting of soft tissue may reduce the complications of high-energy fractures.
【CateGory Index】: R687.3
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