The occurrence of an open fracture does not essentially prevent fracture bracing methods. However, the applications and usage of fracture bracing are limited. Nowadays, orthopedic surgical instruments manufacturers and Spine Implants specialists prefer external fixators as the treatment of choice for rickety Gustilo type II and III fractures. Gustilo is the most widely used classification system for open fractures. Significant progress has been made with the use of no reamed intramedullary nails in the Delta Tibia / Femur Nailing System.
These nails are widely used in the healing of unstable open fractures of type I and II and possibly in some type III fractures of the tibia bone. As orthopedic products manufacturers in India, we believe that it is immature to consider that a non reamed nail does not damage the intramedullary circulation. Also, it must be understood that in fractures that are not firmly immobilized, it is the peripheral blood supply which is responsible for the process of becoming vascular and further healing of the fracture. The role of the medullary circulation, under those circumstances, is rather negligible. More effectual antibiotics and appropriate removal of damaged tissues with proper wound care have extended the indications for internal fixation of open fractures.
The more the level of soft tissue damage, the increased is the instability of open fractures. This further demand a delay in the introduction of functional bracing at the open fracture site.
Hence, we can conclude that open fractures must be braced later and for an extended time.
Top orthopedic implant company and medical professionals believe that in order to reduce the incidence of infection in open fractures, it has should be best left open or should be closed after a few days.
Musculocutaneous flaps, which are generally a mass of tissue used for grafting, have provided with a much better diagnosis in very complex, open type III fractures.
The knowledge collected during military
clashes suggests that a granulation tissue can effectively close a wound by
secondary intention. All this can be achieved without the use of skin grafts or
primary closure.
However, the new skin formed often binds itself to the underlying bone and,
since it is thinner and weaker in nature, it is likely to break down under
minor shock. Trauma implants experts have observed that if the function is
maintained during the healing process, abnormalities in adhesion and limitation
of motion of the skin are less likely to occur.
In the presence of an open wound, it is generally advisable to delay the application of a plastic brace until the soft tissue drainage has been reduced significantly.
Apart from this, daily examination of the wound is necessary in order to avert the breaking down of the skin resulting from prolonged exposure to moisture, which can occur as a result of the plastic material’s inability to absorb fluids.
Open fractures that are not treated within intramedullary nails (used in Delta Tibia / Femur Nailing System), particularly those with a high amount of soft tissue damage are frequently linked with unnecessary and undesirable shortening.
Such fractures usually demand the use of an external fixator for some time. Generally, it is used prior to the application of a fracture brace. In modern times, external fixators have regained back their popularity and are used as a means of restoring length in such limbs. This method has a specific place in the orthopedic treatment but must be used sensibly. Regardless of the number of pins used in the external fixators, their slackening is often observed with secondary irritation and infection in the contained bone.
Orthopedic implants specialists have
attempted to improve the fixation by increasing the number of pins and the
rigidity of the fixator. But, this will necessarily deprive the bone of the
physiologic stresses and the normal stimuli of function as well as the
intermittent motion which is necessary for optimal fracture healing.
Our experience in the orthopedic surgical instruments business has suggested
that pins should be removed soon after the growth of the fundamental stability
of the soft tissues in order to reduce any shortcoming that occurs due to
prolonged and rigid immobilization. However, this early removal in the case of
open tibial fractures is also plagued with complications. Since the fibula,
which is not immobilized, heals quicker than the tibia, a condition is created where
a fracture of the tibia persists with a united fibula. Therefore, in such
cases, Varus deformities are likely to occur due to due to underweight-bearing
conditions. The tibial fracture with an intact fibula remains a challenge for
an orthopedic implant’s specialist.
