Abstract
The closure of small-to-moderate-sized soft tissue defects in open tibial fractures can be successfully achieved with acute bony shortening. In some instances, it may be possible to close soft tissue envelope defects by preserving length and intentionally creating a deformity of the limb. As the soft tissue is now able to close, this manoeuvre converts an open IIIb to IIIa fracture. This obviates the need for soft tissue reconstructive procedures such as flaps and grafts, which have the potential to cause donor-site morbidity and may fail. In this article, the authors demonstrate the technique for treating anterior medial soft tissue defects by deforming the bone at the fracture site, permitting temporary malalignment and closure of the wound. After healing of the envelope, the malalignment is gradually corrected with the use of the Taylor Spatial Frame. We present two such cases and discuss the technical indications and challenges of managing such cases.
Highlights
Gustilo and Anderson type III open tibial fractures are limb-threatening injuries with an average union time of between 28 and 52 weeks [1, 2]
The closure of small-to-moderate-sized soft tissue defects in open tibial fractures can be successfully achieved with acute bony shortening
As the soft tissue is able to close, this manoeuvre converts an open IIIb to IIIa fracture
Summary
Patient and injury selection for this technique is critical. Such decisions must be made by a surgeon proficient in the techniques of adult tibial deformity correction and be made in conjunction with the patient. Fracture pattern: A prerequisite of this technique is that bones should be deformable in the direction of the skin defect This makes a fibula fracture close to the level of the tibial injury a necessity. All fragments of bone must be viable, and any devitalised fragments of bone should be removed at the primary debridement In both cases, correction was commenced late so as to ensure complete wound healing. In the absence of comminution, overlapping the fracture fragments may be possible to allow shortening and wound closure, but we have no experience of this technique We believe that this technique may be suitable for open supramalleolar distal tibial fractures, open diaphyseal fractures and open fractures of the subtuberosity proximal tibia. As local flap options are often more restricted in the
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