Bilaga ansökan Skaraborgs FoU 2011-10-01 Telmo Ramos ”Om behandling av tibiafrakturer
med Ilizarov extern fixation”
I
Ilizarov external fixation or Intramedullary Nailing for treatment of diaphyseal
tibial fractures – a randomized prospective study. Telmo Ramos, Carl Ekholm, Jón
Karlsson, Lars Nistor.
All datainsamling är klar sommaren 2011 inkl 1 års-uppföljning av samtliga patienter. Analys har
påbörjats och under oktober kommer jag att gå igenom detta med statistiker Salmir Nasic. Utkast
till artikel avseende Inledning, metod och preliminär diskussion har påbörjats. Vi kommer att
välja tidskrift när vi ser resultaten. Eftersom det rör sig om en prospektiv randomiserad
undersökning inom frakturkirurgi (där sådana är ovanliga) räknar vi med att få acceptans av
någon av de “tunga” internationella tidskrifterna.
II
The Ilizarov external fixator a useful alternative treatment for proximal tibial
fractures. A prospective observational study of 30 patients. Telmo Ramos, Carl
Ekholm, Jón Karlsson, Lars Nistor. IN MANUSKRIPT- Archives of Orthopaedic
Trauma Surgery hösten 2011
Abstract
Introduction The purpose of the treatment of proximal tibial fractures is to obtain a stable, painfree knee joint with a restored range of motion and enough congruence to avoid post-traumatic
osteoarthritis. The most frequently used treatment is ORIF with screws and plates. Minimallyinvasive techniques using external fixation are an alternative. The aim of this study was to
analyse the results using the Ilizarov technique in both uni- and bicondylar tibia fractures.
Methods Thirty consecutive patients with isolated fractures of the proximal tibia were treated
with the Ilizarov technique, 11 Schatzker I-IV with 2-3 rings and 19 Schatzker V-VI with 3-4
tibial rings and a femoral hinged two-ring extension. Unrestricted weight bearing was allowed.
Post-operatively conventional radiographs, CT scans, postoperative pain assessment and
complications were evaluated. The knee function was evaluated with the EQ-5D, NHP and
KOOS scores and self-appraisal as well.
Results All the fractures healed. Twenty-five patients achieved a range of motion better than 10100º. The type I-IV fractures had a shorter operating time and hospital stay, as well as better knee
flexion and the self-appraisal indicated that they tolerated the treatment better. Pin infections
ocurred in 4% of the pin sites, however, only two patients needed debridement. Two patients
developed compartment syndrome and underwent fasciotomy. Three patients had unstable knees
at follow-up. Two patients underwent a total knee arthroplasty because of residual pain. The
overall result was satisfactory in twenty-six patients.
Conclusions The Ilizarov method produces a good clinical outcome and can be recommended in
proximal tibial fractures of all types.
III
Treatment of distal tibial fractures with the Ilizarov external fixator. Telmo
Ramos, Carl Ekholm, Jón Karlsson, Lars Nistor. IN MANUSKRIPT - Archives of
Orthopaedic Trauma Surgery hösten 2011
Abstract
Background and purpose: The most frequently used treatment for distal tibial fractures is
ORIF with screws and plates, which, however, has a relatively high complication rate, why a
staged protocol is often recommended. Minimally invasive techniques with external fixation have
been introduced as an alternative and allows for immediate reduction and stabilization. The aim
of this prospective study was to analyze the outcome using the Ilizarov technique in patients with
distal metaphyseal peri- and intra-articular tibia fractures.
Patients and methods: Thirty consecutive patients with isolated fractures were followed
prospectively for one year. Depending on the type of fracture, 4-5 rings were used, sometimes
with a foot extension. Unrestricted weight-bearing was allowed. Post-operatively conventional
radiographs, postoperative pain assessment and complications were evaluated. The function was
evaluated clinically and using self-appraisal with the EQ-5D, NHP and FAOS.
Results: All the fractures healed. No patient developed compartment syndrom or deep venous
thrombosis (DVT). The pin infections were mostly superficial and were treated with antibiotics
or/and removal of isolated pins. Two patients had pin tract infections treated with debridement of
the soft tissues. The fixator was removed after a median period of 16 (range 12-30) weeks. One
patient had a pin-tract infection after the removal of the fixator, which required reoperation.
Residual malunion was observed, but in most of patients less than 0.5 cm. Two patients had
major residual deformities, one painful with deep infection, and were reoperated. The overall
result was satisfactory in twenty eight patients.
Conclusions: The Ilizarov method produces a good clinical outcome and can be recommended to
these difficult-to-treat fractures.
IV
Postoperative impact of daily life after primary treatment of proximal/distal tibia
fracture with the Ilizarov external fixator. Marina Modin, Telmo Ramos,
Margareta Warrén Stomberg. J Clin Nurs 2009, 18:3498-3506
Abstract
Aims and objectives. To describe patients’ experience of the impact of their health-related life
situation on their daily life two and four weeks after primary fracture treatment with Ilizarov
external fixation.
Background. A few studies have been conducted postoperatively focussing on fracture treatment
with Ilizarov fixation.
Design. A prospective descriptive research design.
Method. Patients who had been treated for a proximal/distal tibial fracture were invited to
participate in the study. Data were collected with a semi-structured questionnaire where 20
patients described in their own words their situation at home two and four weeks postoperatively.
The process used when analysing the data was similar to content analysis.
Results. Four key themes were identified: ‘limitations in the home environment’, ‘limitations
outside the home’, ‘limitations to social relations’ and ‘experience of having an Ilizarov fixation’.
The patient’s life situation was strongly affected during the first postoperative month. This took
the form of clear limitations on activities outside the home and a degree of limitation on coping
with household chores and personal hygiene. These limitations became less severe after between
2–4 weeks and were very much a consequence of using crutches.
Conclusion. This study points to limitations in the patient’s daily life situation in the home. The
results from the study make it obvious that the information given to patients prior to discharge,
concerning the value of putting weight on the leg, had not been clear or that the patients had not
understood it. This had a negative impact on the patient’s daily life after discharge. Further data
are needed to uncover the extent of the issue to be able to optimise patient outcomes.
Relevance to clinical practice. There is a need for clearer and more active information from the
nurse before discharge but also a need to follow up how the information given is understood.
V
Gait analysis with insoles in diaphyseal tibial fractures treated with the Ilizarov
external fixator or Intramedullary Nailing – a prospective randomized
comparison. Telmo Ramos, Katarina Hjältman, Tom Köhler, Lars Nistor (?). Gait
Posture 2012 (?)
Datainsamlingen är klar. Den fortsatta analysen har diskuterats vid två dagars besök med Tom
Köhler, gånganalytiker i Berlin. Vi håller på att med hjälp av honom konstruera en ny parameter
– gångeffektivitet - där man väger in gånghastighet, belastning, steglängd, effektiv fotlängd (hur
foten avvecklas i steget) och justerar för kroppslängd och vikt. Vi räknar med att sedan kunna
presentera jämförelsen mellan de olika behandlingsmetoderna med utgångspunkt från denna
parameter och grundparametrar. Dataanalysen har påbörjats och under oktober kommer vi att ha
telefonkonferenser för att diskutera utvärderingen. I detta delarbete kommer dels mätmetoden,
dels resultaten att diskuteras.
VI
Gait analysis with insoles in isolated proximal and distal metaphyseal tibial
fractures treated with the Ilizarov external fixator. Telmo Ramos, Katarina
Hjältman, Tom Köhler, Lars Nistor (?). Gait & Posture 2012 (?)
Jfr V. Informationen blir så omfattande att vi inte räknar med att kunna få acceptans om allt läggs
in i en artikel vilket vore det bästa men vi får istället diskutera resultaten från denna del i
förhållande till föregående artikel.