Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study

Abstract

Introduction: The tibia, the second largest bone in the human body, is largely enveloped by subcutaneous fat and skin, rendering it vulnerable to fractures and soft tissue injuries. This unique anatomical configuration contributes to a heightened susceptibility to open fractures. Notably, an aggressive treatment protocol involving radical debridement, internal fixation, and immediate or early soft tissue coverage with muscle flaps has demonstrated improved rates of bony union and reduced incidences of infection. Aim: To assess the clinical outcomes of early bony fixation and soft tissue coverage in Type IIIB open proximal tibia fractures. Materials and Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, BRD Medical College, in Gorakhpur, Uttar Pradesh, India. Total of 30 cases were enrolled between August 2021 and November 2022. The parameters assessed in the study encompassed patient demographics, including age and gender distribution, the aetiology of fractures, soft tissue coverage outcomes, time to bone union, knee joint movement postsurgery, and the incidence of complications such as superficial infections and chronic osteomyelitis. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26.0, primarily employing descriptive statistics to present the results, with percentages and frequencies serving as the primary modes of representation. Results: All cases of Gustilo-Anderson Type IIIB high-grade open tibial fractures were included in this study, with the majority of patients being males 26 (87%) aged between 20 to 40 years. Road traffic accidents accounted for 25 (83.3%), while falls from height were responsible in 5 (16.7%) cases. Assessment of soft tissue coverage revealed 73.33% with good healing, 20% with fair healing, and 6.67% with poor healing. The time to bone union varied, with 10% of cases showing non union. Postsurgery, most cases demonstrated knee joint movement of over 120° (86.67%) and a few cases with movement ranging between 90-120° (13.33%). The incidence of complications was relatively low, with 3 (10%) cases presenting superficial infections and 2 (6.7%) suffering from chronic osteomyelitis. Conclusion: Early bony fixation and soft tissue coverage utilising the medial gastrocnemius flap, along with Split-Thickness Skin Grafting (STSG), demonstrate efficacy in treating high-grade open proximal tibia fractures (Gustilo-Anderson Type IIIB). This approach facilitates expedited bony union and contributes to a reduction in postoperative complications.