Abstract
ObjectiveThis study aimed to retrospectively analyze clinical data of a series of patients with severe open fractures of extremities (Gustilo IIIb or IIIc), who achieved a satisfactory outcome through radical orthoplastic surgery, so as to provide a reference for determining the treatment of severe open fractures of extremities.MethodsThe clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and January 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed.ResultsThe mean (±SD) age of the patients was 38 ± 16 years. A total of 90 open fractures and severe soft tissue damages were analyzed. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks.ConclusionThe overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a two-stage orthopedic approach. The consequence of infection rate and union time was similar to that in previous studies. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.
Highlights
It has been 20 years since Gopal and Smith et al [1] published their remarkable achievements in dealing with severe open fractures of the tibia by radical orthoplastic approach
In summary, the overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a twostage orthopedic approach
This study indicated that the radical “orthoplastic” treatment was an effective and reliable option for the reconstruction of severe open fractures
Summary
It has been 20 years since Gopal and Smith et al [1] published their remarkable achievements in dealing with severe open fractures of the tibia by radical orthoplastic approach. Similar studies have rarely been reported in recent years This is mainly because severe open fractures (referred to as Gustilo IIIb or IIIc injuries), which often lead to large soft tissue defects and high risk of infection, are still a challenge for reconstructive surgeons [2, 3]. The present popular concept of severe open fracture management aims to achieve soft tissue coverage in an early stage. It is based on the collaboration of orthopedic and plastic (microvascular) surgeons in an “orthoplastic” central unit [8]. Compared with the traditional orthopedic approach in which the primary stabilization of the fracture and delayed wound closure are completed in two stages, the combined “orthoplastic” treatment has advantages such as fewer flap failures, lower infection rate, decreased bone-healing time, and short hospital stay [1, 4]
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