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

Abstract

Introduction: The management of Gustilo-Anderson type-Ⅲ open tibial fracture is complex due to neurovascular damage and soft tissue loss. Combined orthopedics, plastic and vascular surgery provides better result for reconstructing the injuries of limb. The prevalence of tibial shaft fractures is estimated about 67%.1,2 Tibial shaft fractures are approximately 15% of all adult fracture and open tibial fractures are about 23.5%.1 Rigid fixation and good soft tissue coverage are essential for management of the fracture. Ilizarov external fixator, provide multi-disciplinary management of type Ⅲ open tibial fractures with sever contamination and comminution. Purpose of the study: To evaluate the clinical efficacy of Ilizarov external fixator with or without fascio-cutaneous flap transplantation in the management of Gustilo-Anderson type-Ⅲ open tibial fracture. Methodology: In the period of 2020 -2021, we manage 5 cases of Gustilo- type-Ⅲ open tibial fracture by Ilizarov. 2 patients were type-ⅢA and 3 type-ⅢB with severely contaminated and comminution. No neurovascular damage. All are male, age 30 -65 years and caused by RTA. There was 1 diabetic and 1 hypertensive patient. Surgical toileting, debridement and posterior slab apply as immediate management. All patients managed by Ilizarov on 5th and 7th day with secondary closure of type-ⅢA and vascularized fascio-cutaneous flap with skin grafting in type-ⅢB cases by orthopedic and flap surgeon. Summary: Full weight bearing was allowed on 3rd Soft tissue was healed within 3-6 weeks. In 1 case found skin infection, treated by antibiotic and dressing, also 1 case occurred flap edge necrosis, managed by debridement and 2nd time skin graft. Bone union time was 5-6 months, RUST scores 10. According to ASAMI score all were excellent results. Conclusion: RTA is the main cause of type Ⅲ open tibial fractures. Combined multi-disciplinary managements by Ilizarov provide excellent outcomes, early mobilization and infection control. It is a single stage definite management, which reduce treatment cost, patient`s mortality and morbidity.