R. Sandeep Reddy

High-energy tibial shaft fractures in geriatric patients present significant challenges due to osteoporotic bone, compromised soft tissues and multiple medical comorbidities. Conventional fixation methods may be limited in the presence of fracture blisters or poor physiological reserve, making minimally invasive strategies increasingly relevant. An 88-year-old previously independent male with hypertension and prior cerebrovascular accident sustained a high-velocity road traffic injury resulting in an AO/OTA 42C3 comminuted tibial shaft fracture and 4F2B fibula fracture with ipsilateral rib fractures. Early circumferential fracture blebs precluded plating and staged external fixation was avoided due to advanced age and comorbidities. A single-stage four-ring Ilizarov circular fixator was applied using tensioned wires and selective Schanz pins, prioritizing biological fixation and soft-tissue preservation. Postoperatively, the patient followed a staged rehabilitation protocol with adjunctive teriparatide therapy. Radiographs demonstrated progressive callus formation and fracture union at one year with acceptable varus and recurvatum alignment. The postoperative course was uneventful and implant removal was performed after consolidation. Functional outcomes beyond one year could not be assessed due to loss to follow-up. Single-stage Ilizarov circular fixation can be an effective definitive option for complex high-energy tibial fractures in medically complex elderly patients when conventional fixation is contraindicated. Careful consideration of soft-tissue status, comorbidities and biological fixation principles is essential to optimize outcomes.

Background: Periprosthetic joint infection (PJI) after revision total hip arthroplasty (THA) poses significant wound-management challenges. Outcomes following vacuum-assisted closure (VAC) therapy vary and may be influenced by regional microbiology and host soft-tissue characteristics. Methods: This retrospective comparative cohort study (2019-2025) included adults undergoing revision THA for chronic PJI at a tertiary center. Patients were grouped by geographic origin: India (n=20) and Democratic Republic of Congo (DRC; n=18). Demographics, microbiology, postoperative wound gaping, debridement and VAC sessions, soft-tissue reconstruction, and time to complete wound healing were analysed using non-parametric statistics. Results: The Indian cohort was younger (60.3 vs 67.8 years; p=0.010) but required more debridement’s (3.1 vs 2.3; p=0.031), VAC sessions (2.7 vs 1.6; p=0.003), and flap reconstructions (70% vs 22%). Initial wound gaping occurred at a similar postoperative interval in both cohorts; however, healing time was significantly longer in Indian patients (36.8 vs 18.2 days; p=0.002). Klebsiella predominated in the Indian cohort, whereas Pseudomonas was more common in DRC patients. Conclusions: Geographic differences in wound behaviour following revision THA for PJI suggest that regional microbiology and host soft-tissue factors influence VAC effectiveness and healing outcomes, supporting population-specific wound management strategies.