Combined Orthoplastic Approach in the Treatment of Open Fractures of the Leg Bones: a Review of the Literature

Abstract

Open fractures of the lower leg bones with a concomitant soft tissue defect is a rather serious problem in traumatology and orthopedics, as well as in reconstructive surgery. Traditionally, in our country and the CIS countries, with this type of fracture, external fixation is used - transosseous distraction osteosynthesis with the Ilizarov apparatus; often practiced late final closure of the skin defect. Currently, the combined orthoplastic method of treating open fractures of the lower leg is gaining popularity all over the world, which involves osteosynthesis of the fracture and skin plasty of the soft tissue defect of the limb in one stage within 72 hours after the injury, which will significantly reduce the time of treatment of the patient, as well as reduce the risks infectious complications.The purpose of this review article is to study research in the international scientific community on the combined use of traumatology and plastic surgery methods in the treatment of open fractures of the lower leg with an accompanying soft tissue and skin defect, to compare the results of treating this type of injury with an orthoplastic approach and traditional orthopedic, as well as the advantages and disadvantages various methods of osteosynthesis. An information search was carried out for scientific articles in the PubMed, Web of Science, Cochrane, Wiley, Cyberleninka databases, using the keywords “open fracture of the lower leg”, “orthoplastic method”, “Ilizarov apparatus”, “skin plasty”. We analyzed 58 articles published between 1997 and 2022, including information on the epidemiology of open tibial fractures, issues and methods of treating open tibial fractures, and preventing post-traumatic and postoperative complications. This article includes the results of 2 large systematic reviews, 4 meta-analyses, 1 randomized controlled trial (RCT), 2 prospective cohort studies, 2 retrospective cohort studies, and UK and US guidelines.The study concluded that the orthoplastic approach was successful and its advantages over the classical approach in the treatment of open fractures of the lower leg bones, expressed in the reduction of treatment time, optimization of care for patients with open fractures of the lower extremities. In addition, according to reports of various scientific studies, the orthoplastic approach also gives good results in terms of reducing the risk of post-traumatic complications in patients and improving the functional outcome of the injured limb.Key words: combined orthoplastic approach, open fracture of the leg bones, reconstructive surgery.