Clinical treatment of Gustilo III open tibial fractures

Abstract

Objective To study treatment protocols for Gustilo Ⅲ open tibial fractures. Methods Forty-six cases of open tibial fracture were treated surgically. They were 30 males and 16 females, with an average age of 31.2 years (range, 16 to 55 years) . The average time from injury to surgery was 8.5 hours (range, 4 to 24 hours). By Gustilo classification, there were 22 cases of ⅢA, 17 cases of ⅢB, and 7 cases of ⅢC. By AO classification, there were 3 cases of A3, 7 cases of B2, 9 cases of B3, 5 cases of C1, 11cases of C2, and 11 cases of C3. All the patients underwent debridement to clean the wounds. Two cases underwent vacuum-sealing drainage (VSD) before re-debridement. Flaps of different kinds were used. External fixation was used in 23 cases, plating in 11 and internal fixation with interlocking intramedullary nails in 12. Results All the patients were followed up for an average of 14. 2 months (range, 8 to 24 months).Satisfactory healing was obtained in 39 cases. Superficial infection occurred in 2 cases, skin edge necrosis occurred in 2 cases, deep infection occurred in 2 cases which was controlled by VSD. The infection rate was 10. 9%. The mean time of bone union was 4.5 months in 41 cases. Three cases of original external fixation were changed into intramedullary nail fixation and healed in 4 months. One case of plate breakage had to change into external fixation and healed 5 months later. One case of malunion was corrected by osteotomy. By Johner-Wruhs classification, 29 cases obtained excellent results, 14 good, 2 fair and one poor, with a good to excellent rate of 93.5%. Conclusion To achieve fine curative effects and prognosis, developing a good surgical plan may be more significant than following the strict requirement on timing of surgery. Key words: Tibial fractures; Fractures, open; Surgical flaps