The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage

Abstract

We studied the outcome and functional status of 33 patients with 34 severe open tibial fractures (Gustilo grade IIIb and IIIc). The treatment regime consisted of radical debridement, immediate bony stabilisation and early soft-tissue cover using a muscle flap (free or rotational). The review included standardised assessments of health-related quality of life (SF-36 and Euroqol) and measurement of the following parameters: gait, the use of walking aids, limb-length discrepancy, knee and ankle joint function, muscle wasting and the cosmetic appearance of the limb. Personal comments and overall patient satisfaction were also recorded. The mean follow-up was 46 months (15 to 80). There were 30 Gustilo grade IIIb fractures and and four grade IIIc fractures. Of the 33 patients, 29 had primary internal fixation and four, external fixation; 11 (34%) later required further surgery to achieve union and two needed bone transport procedures to reconstruct large segmental defects. The mean time to union was 41 weeks (12 to 104). Two patients (6.1%) developed deep infection; both resolved with treatment. The mean SF-36 physical and mental scores were 49 and 62 respectively. The mean state of health score for the Euroqol was 68. Patients with isolated tibial fractures had a better outcome than those with other associated injuries on both scoring systems. Knee stiffness was noted in seven patients (21%) and ankle stiffness in 19 (56%); 12 patients (41%) returned to work. Our results compare favourably with previous outcome measurements published for both limb salvage and amputation. All patients were pleased to have retained their limbs.

Decreasing incidence of tibial shaft fractures between 1998 and 2004: Information based on 10,627 Swedish inpatients

“…Orthopedic training may be compromised because of the reduced fracture incidence. Patients might benefit from the competence gathered at specialized centers with intensive multidisciplinary involvement to cover all the diagnostic and treatment options required (Gopal et al 2004).…”

Comparison of 39 post-traumatic tibia bone transports performed with and without the use of an intramedullary rod: the long-term outcomes

“…Gopal et al studied the outcome of patients with open tibial fractures (Gustilo grade IIIb or IIIc) and found that only 40% of them returned to work [23].…”

Classifications In Brief: The Tscherne Classification of Soft Tissue Injury

“…The initial evaluation of a patient with orthopaedic trauma must include a detailed assessment of the soft tissue envelope. The timing and method of fracture fixation are directly influenced by the degree of trauma to the overlying soft tissues and have been shown to have a direct effect on postoperative function [5,8,13,14,17].…”