Background
Gustilo type III tibial fractures commonly involve extensive soft tissue and bony defects, requiring complex reconstructive operations. Although several methods have been proposed, no research has elucidated the efficacies and differences between vascular bone graft (VBG) and the Masquelet technique (MT) to date. We aimed to evaluate and compare the clinical effectiveness of VBG and the MT for the reconstruction of Gustilo type III tibial fractures.
Methods
This retrospective cohort study enrolled patients who underwent reconstruction for Gustilo type III tibial fractures using VBG or the MT in a single center from January 2000 to December 2020. The patients’ demographics, injury characteristics, and surgical interventions were documented for analysis. The clinical outcomes including union status, time to union, postoperative infections, and the causes of union failure were compared between the two groups.
Results
We enrolled 44 patients: 27 patients underwent VBG, and 17 underwent MT. The average union time was 20.5 ± 15.4 and 15.1 ± 9.0 months in the VBG and MT groups, respectively (p = 0.232). The postoperative deep infection rates were 70.4% and 47.1% in the VBG and MT groups (p = 0.122), respectively. Though not statistically significant, the VBG group had a shorter union time than did the MT group when the bone defect length was > 60 mm (21.0 ± 17.0 versus 23.8 ± 9.4 months, p = 0.729), while the MT group had a shorter union time than did the VBG group when the bone defect was length < 60 mm (17.2 ± 5.6 versus 10.7 ± 4.7 months, p = 0.067).
Conclusions
VBG and MT are both promising reconstruction methods for Gustilo type III tibial fractures. VBG appears to have more potential in reconstructing larger bone defects, while MT may play an important role in smaller bone defects, severe surgical site infections, and osteomyelitis. Therefore, flexible treatment strategies are required for good outcomes in Gustilo type III open tibial fractures.
Background: We aimed to assess the factors that affect union time and complications in IIIC (based on the Gustilo classification) tibial fractures.
Materials and Methods: This retrospective analysis included patients with IIIC open tibial fractures during a 20-year period. All the medical records were reviewed, and the outcomes were investigated.
Results: Fifty-eight patients were enrolled and grouped by union time: on-time (eight), late (27), delayed (eight), non-union, and amputation required (12). Nine fractures were complicated by osteomyelitis. Union time was significantly prolonged in cases of triple arterial injury, distal third fractures, an Injury Severity Score (ISS) ≥ 16, and/or increased length of bone defect. A bone gap > 50 mm, diabetes mellitus, low body mass index, or triple arterial injury were significant risk factors for amputation. Time from injury to definitive soft tissue coverage was a major risk factor for osteomyelitis if it exceeded 22 days. Predicted probability of union within 2 years was stratified based on a generated scoring system.
Conclusions: An effective system predicting union time was built based on the selected factors. Early soft tissue coverage reduces the risk of osteomyelitis, while diabetes and severe bone and soft tissue defects increase the risk of amputation.
Trial registration: not applicable
Level of evidence: IV
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