Exposed Bone Syndrome: Classification and Scoring of Exposed Long Bone

摘要

Introduction: There is paucity of literature on exposed bone (EB) classification. We aimed at classification and scoring of exposed long bones of limb. Patients and Methods: A clinical based observational prospective non-randomized three years study of EB was evaluated at tertiary teaching hospitals. Patient's informed consent and institutions ethical clearance were obtained. Research question was EB's are not the same. The type I (AEB) and type II (CEB) were EB occurring for less than six weeks or more respectively. The type I and II EB patients constituted what we coined "Exposed Bone Syndrome" (EBS). One major symptom and one major sign with two or more symptoms and two or more minor signs constituted diagnostic EBS criteria. The measuring instrument was Ile- Ife EBS protocol. Outcome measures were duration of hospital stay and mortality. Data was analyzed with SPSS version 11.0 software using Pearson correlation, Yates's coefficient, Spearman correlation, Mantel-Haenszel odd ratio package. The alpha error level was p<0.05. Results: A total of 155 EB patients (111 males=71.6%; 44 females= 28.4%) with 74.2% in lower limb and 25.8% in upper limb met the inclusion criteria's. Trauma was the main predisposing factor to EB (p<0.000). The age, sex, religion, location of EB, body side involvement, blood use, genotype, fever and blood chemistry were not significant. The presence and number of EB, bone viability ,length of bone exposed, haemogram, microorganism, pain, bleeding, recurrent discharge ,deformity ,sinuses, joint exposure, putrefying odor , hyper pigmentation, hypo pigmentation ,exuberant hair growth ,puckered scar, rocking detachment and limb length discrepancy were significant symptoms and signs (p<0.05) in EB classification. A preliminary scoring of the significant clinical features of EB that ranged from 9-44 was documented. Conclusion: Exposure of bones is often seen in clinical orthopedics practice. Management of exposed bone portends a great challenge to the surgeons. Exposed bone syndrome is a distinct clinical entity that could be classified into two types using Ile Ife diagnostic protocol. Mclanre Exposed Bone Scoring System (MEBSS) is simple to apply and reproducible for epidemiology and management of exposed bone. Introduction Bone retains the capacity to alter its shape and structure in response to changes in its environment 1. Accidents related to road traffic, industrial machinery or farming can result in mangling injuries with bone exposure. The goals of skeletal fixation in this setting should include: stabilization of the skeleton in order to protect the vascular repair, facilitation of early mobilization of both the articulations and the gliding musculotendinous structures of the limb, facilitation of wound care and reconstruction of soft tissue envelope and healing of all fractures including those associated with bony defects2 . Adequate debridement remains the most important factor in prevention of chronic sepsis in cases of massive limb trauma. All bony fragments with marginal soft-tissue attachments and exposed bone without evidence of adequate blood flow must be removed during debridement for optimal results 3. When the fracture site is infected and contains necrotic fragments, the superiority of external fixation over internal fixation is obvious. The method makes it possible to stabilize the fragments without interfering with local healing and allows the exposed bone to be covered in a stable environment 4. Exposure of bones is often seen in clinical orthopedics practice in the developing countries. Management of EB portends a great challenge to the surgeons and this often varies with the etiology and mode of presentation. There is paucity of literature on exposed bone in sub-Saharan Africa. The problem of exposed bone has been of long standing but no clear pattern has been described. This study is aimed at evaluation of a new classification and scoring system for exposed bone as seen at tertiary