Outcome of External Fixator Management of Gustilo Anderson Type III Tibial Fractures in Lagos University Teaching Hospital

Abstract

Type III open tibial fracture is the commonest type of open tibia fracture. The aim of this study was to determine the outcome of Gustilo-Anderson type III open tibial fracture managed with external fixator. Patients that presented with Gustilo-Anderson type III open tibial fractures were recruited. Patients with bone pathology, prior debridement and concomitant spinal cord injury were excluded. Ethical approval and informed consent were obtained. A structured proforma was used to collect the participant’s socio-demographic data, time of injury, fracture location, interval and number of debridement, need for skin graft or flap, duration of hospital stay, outcome of treatment, complications and events at follow-up. Wound biopsy was taken and processed for microscopy, culture, and sensitivity. Delayed union was diagnosed when the fracture united between 4-6 months. Non-union was defined as a varus or valgus angulation of >5 degrees or anterior or posterior angulation of >10 degrees. Patients were followed up for 6 months. Chi square was used to determine association between categorical variables. SPSS 20 was used for analysis. Significance was p value <0.05. Of 35 patients, males were 22 (62.9%) while females were 13 (37.1%) and mean age was 38 years. Average interval between injury and presentation was 14.5 hours. Fourteen (40%) patients had type IIIA, 18 (51.4%) patients had type IIIB while 3 (8.6%) patients had type IIIC. Mean time to fixation was 59.2 hours. Wound infection, malunion, delayed union, pin loosening and compartment syndrome were found in 42.9%, 21.3%, 21.3%, 11.5% and 1.6% respectively. Infection rate was significantly positively correlated with grade of fracture (p=0.04) and time to debridement (p=0.018). A significant association between the mechanism of injury and associated injury (p=0.027) but not mechanism of injury and grade of type III fracture (p=0.292). Significant difference between the duration of hospital stays and categories of type III fractures (p = 0.026) but not associated injury (p=0.403). No significant difference in location of fracture and time of union (p=0.723). Type III fractures managed with external fixator is associated with some complications among which infection is the commonest and delay in treatment is associated with higher risk. Post-debridement microscopy and culture is a better predictor of wound infection.

A single stage management procedure of gustilo type-III open tibial fractures by Ilizarov with secondary clouser and flap transplantation: an article

“…Wound debridement <48 hours, the infection rate is 20% and >48 hours it is 60%. 4 On successive days wound dressing was done every alternative day. The patients were used NSAIDs during treatment.…”

“…Other study describes fractures patterns are mostly comminuted (25.7%) and mid shaft of tibia are mostly affected (14.3%). 4 Previously, primary amputation was done in severely injured leg. Secondary amputation of the limb predominated among the patients of Gustilo-Anderson type-ⅢB open tibial fracture was-25% and type-ⅢC-75% due to serious complication like-infection, soft tissue loss and neuro-vascular damage.…”

“…1 GA type-Ⅲ open tibial fracture associated with others long bone fracture is about 2.9%. 4 Now various studies suggested that salvage is a cost benefited strategy that provides a better quality of life than amputation. 1 Combined orthopedics, plastic and vascular surgery provides more options for reconstructing the injured limb of Gustilo-Anderson type-Ⅲ open tibia fracture.…”

“…Fractures patterns are mostly comminuted (25.7%) and mid shaft of tibia are mostly affected (14.3%). 4 Infection is the major complication and the rate is 28.6% in ⅢA, 44.4% in ⅢB and 100% in ⅢC open tibial fracture. Secondary amputation needed 25% in type ⅢB and 75% in type ⅢC tibial fracture.…”

“…In ⅢA, primary closure done-35.7% and secondary closure-21.4%, ⅢB, secondary closure done-44.4%, skin graft-27.8% and flap-27.8% and ⅢC, flap done-3%. 4 Reamed nailing is the choice of open tibial fracture treatment with less contamination and fragment comminution. Application of external fixation has great success rate.…”