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2018, vol. 57, br. 4, str. 22-28
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Primarna obrada rane i spoljna skeletna fiksacija u lečenju otvorenih preloma tibije
Primary wound care and external skeletal fixation in surgical treatment of open tibial fractures
Golubović Ivanaa, Stojiljković Predragb, Golubović Ivanc, Radovanović Zorand, Radojković Milane, Mitić Aleksandara, Baščarević Zoranf, Kutlešić Katarinac, Krstić Andrijaa, Najman Stevoa  , Golubović Zoranb
aUniverzitet u Nišu, Medicinski fakultet bUniverzitet u Nišu, Medicinski fakultet + Klinički centar Niš, Klinika za ortopediju cKlinički centar Niš, Klinika za ortopediju dUniverzitet u Nišu, Medicinski fakultet + Klinički centar Niš, Centar za radiologiju eUniverzitet u Nišu, Medicinski fakultet + Klinički centar Niš, Klinika za opštu hirurgiju fUniverzitet u Beogradu, Medicinski fakultet, Institut za ortopedsko-hirurške bolesti 'Banjica'
e-adresa: doktorzorangolubovic@gmail.com
Projekat: Virtuelni koštano zglobni sistem čoveka i njegova primena u pretkliničkoj i kliničkoj praksi (MPNTR - 41017)
Sažetak
Otvoreni prelomi tibije spadaju u najteže ortopedske povrede. Zbog svog položaja u lokomotornom sistemu, potkolenica se često povređuje. Povrede kože i mekog tkiva potkolenice, kominukacija kosti i prateće infekcije čine lečenje ovih preloma naročito složenim. Lečenje otvorenih preloma potkolenice je potencijalno povezano sa brojnim komplikacijama. U radu se prikazuju rezultati operativnog lečenja 36 pacijenata sa otvorenim prelomom potkolenice, koji su lečeni u Klinici za ortopediju i traumatologiju Kliničkog centara u Nišu u periodu od 1. januara 2012. do 31. juna 2014. godine. Kod svih pacijenata, nakon primarne obrade rane, odstranjivanja stranih tela, debridmana i odloženog zatvaranja rane, polomljeni koštani fragmenti su reponirani i stabilizovani korišćenjem spoljašnjeg skeletnog fiksatora. Kod 28 pacijenata (77,78%) prelom je zarastao bez većih komplikacija, dok je kod 8 (22,22%) pacijenata došlo do većih komplikacija, uključujući osteomijelitis tibije kod tri (8,33%) i nezarastanje preloma kod 5 (13,88%) pacijenata. Primarna obrada rane, spoljna skeletna fiksacija, antibiotska i antitetanusna profilaksa su ključni u lečenju otvorenih preloma tibije.
Abstract
Open tibial fractures are the most severe orthopaedic injuries. The lower leg is often injured due to its position in the locomotor system. The injuries of the lower leg skin and soft tissues, bone comminution and threatening infections make the treatment of these fractures particularly complex. The management of open tibial fractures is potentially associated with numerous complications. The data on treatment outcomes of 36 patients operatively treated for the open tibial fractures in Clinic for Orthopaedic surgery and traumatology, Clinical Center Nis in Serbia during the period from January 1, 2012 to June 31, 2014 were retrospectively analyzed and compared. In all the patients, after thorough wound rinsing, removal of the foreign bodies, debridement and delayed wound closure, fractured bone segments were repositioned and stabilized using external fixator. In 28 (77.78%) patients fractures healed without major complications, while in 8 (22.22%) major complications occurred, including tibial osteomyelitis in 3 (8.33%) and fracture malunion in 5 (13.88%) patients. Primary wound care, external fixation, antibiotic and antitetanus prophylaxis are crucial in treatment of open tibial fracture.
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