Efficacy of Pie-Crusting Technique on Soft Tissues in Distal Tibia and Fibula Fractures |
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| Affiliation: | 1. Assistant Professor, Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey;2. Orthopedic Surgeon, Department of Orthopaedics and Traumatology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey;3. Professor, Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey;1. Resident, Westside Regional Medical Center, Plantation, FL;2. Board Member, Foot and Ankle Research Foundation of South Florida, Inc., Plantation, FL;3. Doctor of Medical Dentistry Candidate, Nova Southeastern College of Dental Medicine, Plantation, FL;4. Residency Director, Westside Regional Medical Center, Plantation, FL;5. Director of the Statistical Consulting Center, Nova Southeastern University, Fort Lauderdale, FL;1. Orthopaedic and Trauma Surgeon, Department of Orthopaedics and Traumatology, SBÜ Ankara Numune Training and Research Hospital, Ankara, Turkey;2. Associate Professor, Department of Orthopaedics and Traumatology, SBÜ Ankara Numune Training and Research Hospital, Ankara, Turkey;3. Radiologist, Department of Radiology, Hacettepe University, Ankara, Turkey;4. Associate Professor, Department of Radiology, SBÜ Ankara Numune Training and Research Hospital, Ankara, Turkey |
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| Abstract: | Distal tibia and fibula fractures are challenging injuries to treat as evidenced by the high rates of wound complications because of vulnerable soft tissue coverage. The aim of this study was to examine the effect on soft tissue complications of the pie-crusting technique when applied between 2 incisions in distal tibia and fibula fractures treated with open reduction and internal fixation. We reviewed 34 patients with distal tibia and fibula fractures treated between September 2014 and March 2017. The pie-crusting technique was performed during wound closure in 16 (47.06%) fractures (group 1) and classic wound closure was done in 18 (52.94%) fractures (group 2). The primary outcome was evaluated as the presence or absence of soft tissue complications such as superficial skin necrosis, deep skin necrosis, and deep infection. The mean age was 50.44 ± 13.51 (range 23 to 65) years in group 1 and 51.67 ± 14.49 (range 18 to 68) years in group 2. The mean follow-up time was 27.35 ± 9.02 (range 16 to 46) months. The mean surgery time after injury was 5.88 ± 3.5 (range 1 to 14) days in group 1 and 7.32 ± 4.25 (range 1 to 16) days in group 2. No soft tissue complications were seen in any patient in group 1. Five (27.77%) occurrences of superficial skin necrosis were observed in group 2. In 2 (11.11%) patients in group 2, deep necrosis and wound dehiscence occurred, and subsequent deep infection developed in 1 (5.55%) of these patients. The overall complication rate was higher in group 2 (p = .005). We believe that the pie-crusting technique is beneficial for wound closure in distal tibia and fibula fractures, because it reduces the tension of the skin and allows leakage of subcutaneous fluids. |
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