External Fixation and Pedicled Muscle Flaps in Complex Open Tibia Fractures

Abstract

The patient with a complex open fracture of the tibia presents a difficult problem. The high energy traumatic forces cause displacement and comminution of the bone and soft tissue damage with associated skin loss, all of which complicate treatment. Wound healing in these complex injuries implies healing of the soft and hard tissues. The concept of the open fracture wound, which involves the bone, the periosteum, the muscle, the fascia, and the skin, emphasizes the interrelated healing process of the soft and the hard tissues (Jones and Cierny, 1980). Management of such complex open tibia fractures by external skeletal fixation stabilizes the fracture and allows ready access for soft tissue wound Observation. Karlstrom and Olerud (1975) documented less wound healing disturbances when Type II or Type III open tibia fractures were treated with external rather than internal fixation. They hypothesized that the creation and maintenance of a favorable mesenchymal milieu accomplished by transportation of pedicle muscle flaps would enhance soft and hard tissue healing in Type III tibia open fracture wounds.