Purposive bone shortening––a technique which aided soft-tissue coverage in a Grade III Gustillo–Anderson Open Distal Third Leg Fracture: A case report and treatment strategy

Abstract

Problems faced in open fractures of the distal third tibia are usually associated with soft-tissue coverage, infection control, and union of the bone. Tibia is commonly associated with impaired healing if soft tissues are severely damaged. Not all cases can be treated with flaps due to its unavailability in acute settings, high learning curve, and cost. We present the outcomes of a case of an open Grade III-B Gustillo–Anderson distal tibia fracture treated with debridement and deliberate bony shortening which helped in primary closure of the wound. A 61-year-old gentleman, a known hypothyroid, had an alleged history of accidental cut injury over right lower limb by a machine used for cutting trees. He sustained a 7 cm × 4 cm laceration over the anteromedial aspect of the distal tibia with blown-out soft tissues and bone exposed. Wound debridement and stabilization with ankle spanning external fixation were immediately done. Wound could be primarily closed because the tibia and fibula were deliberately shortened during the external fixation. Many free bone fragments were removed during debridement leaving a bony void. One week later bone graft was used to fill the void after redebridement of the wound and wound could be primarily closed. Negative wound therapy was used as an adjuvant. One month later the external fixator was converted to Ilizarov fixator, which was removed at the end of 5 months, showing a fully healed fracture without soft-tissue complications at the end of 6 months follow-up. Debridement and shortening of the open tibia is a powerful technique to provide bony apposition and allow primary wound closure without tension, averting the need for any secondary reconstructive procedures.