Delayed presentation of IIIB tibial fractures: outcome following management in a specialist centre

Abstract

The aim of this study was to assess whether the outcome of delayed presentation of open tibial fractures from neighbouring orthopaedic units can be salvaged in a specialist ortho-plastic centre. All grade IIIB tibial fractures treated in a specialist unit over an 18-month period were retrospectively reviewed. Time to definitive soft tissue coverage, complications, number of operations and method of skeletal and soft tissue reconstruction were also reviewed. The functional outcome was assessed using the Enneking score. Forty-five consecutive patients (27 male and 18 female; mean age, 42.3 years) were treated using strict surgical protocols. Seventeen patients were referred locally, and 28 from seven neighbouring orthopaedic units. The mean time from injury to definitive surgery was 3.9 and 7.7 days for patients referred locally and those referred from neighbouring units, respectively. Definitive surgery, from the time of initial plastic surgery assessment, was performed at a mean of 2.4 days for patients referred locally and 2.8 days for patients referred from neighbouring units. One patient developed a deep soft tissue wound infection. There were no delayed amputations or any cases of infected non-union. Patients from neighbouring units underwent, on average, one extra operation. There was a delay from the time of injury in achieving soft tissue coverage in these patients (7.7 vs. 3.9 days). No significant difference in return of limb function between the two groups was detected. Referral to a specialist centre may produce equivalent functional return even if there is a delay in definitive treatment, at the expense of further risky surgery.