The management of type III open tibial fractures

Injury
K M ChanP C Leung

Abstract

In extensive type III open tibial fractures, limb salvage is considered worthwhile when there is good distal circulation and nerve function. The use of the external fixator has revolutionized the management of skin and soft tissues. However, the subsequent morbidity is still high. A retrospective study of 17 cases is analysed: the amputation rate was 6 per cent, delayed union 60 per cent, infected non-union 30 per cent and mal-union 40 per cent. The final functional result was good in 13 per cent of cases, satisfactory in 30 per cent, fair in 30 per cent and poor in 27 per cent. All patients preferred a functional limb to a prosthesis. The technique of using external fixation and the subsequent management are discussed. To improve the result, we recommend perfect alignment, fixation of the fracture with semi-rigid external fixation and early cancellous bone grafting for comminuted fractures and bone loss. Secondary internal fixation using implants is not advisable. A radical approach is necessary in infected ununited fractures. This includes excision of dead and contaminated tissue and the insertion of gentamicin methyl methacrylate bead implants. Although the complication rate is high and the rehabilitation period is prolonged...Continue Reading

References

Oct 1, 1978·Clinical Orthopaedics and Related Research·S OlerudG Danckwardt-Lillieström
Oct 1, 1979·The Journal of Trauma·E Karaharju, S Santavirta
Apr 1, 1976·The Journal of Trauma·E B WeisP H Curtiss
Jan 1, 1981·Injury·D Campbell, G E Kempson
Jan 1, 1981·Injury·G E Kempson, D Campbell
Jan 1, 1981·British Journal of Plastic Surgery·B Haeseker, M F Green

Citations

Jan 1, 1988·Archives of Orthopaedic and Trauma Surgery·A NesbakkenA Walløe
Aug 17, 2014·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Cemal FiratSerkan Erbatur
Jul 1, 1997·Journal of Orthopaedic Trauma·C S BartlettE C Yang
May 3, 2007·Journal of Orthopaedic Trauma·Panagiotis KoulouvarisNikolaos Demertzis
May 1, 1995·The Journal of Trauma·K YokoyamaH Kai
Aug 10, 2010·Clinics in Podiatric Medicine and Surgery·Vasilios D PolyzoisGeorge Macheras
Sep 15, 2015·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Sherif M IsaacHany Mourkus
Jul 1, 1995·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·A N AcelloN M Pachuda
May 1, 1997·Clinical Orthopaedics and Related Research·J F KeatingH M Broekhuyse
Mar 23, 2020·OTA International : the Open Access Journal of Orthopaedic Trauma·Yousif AtwanDavid Teague

Related Concepts

Teens
Fracture Fixation
Fractures, Open
Postoperative Complications
Retrospective Studies
Tibial Fractures

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