Soft-tissue and bone reconstruction in compound fractures of the lower leg.

Abstract

Open fractures of the lower leg should be treated in co-operation with orthopaedic and plastic surgeons. This is because tibia is largely surrounded with thin soft tissue envelope, which results that compound fractures expose the bone leading easily to soft tissue defect, infection and bone healing problems. When planning the treatment, the mechanism of trauma should be carefully considered; high-energy fractures must be identified. Compound fractures of the lower leg are usually traffic, industrial or farming accidents or gun shot injuries. The amount of bacterial contamination must be considered; usually farming or gun shot injuries are highly contaminated. Also the age and general health (multiple trauma, systemic diseases) of the patient influence the choice of treatment. Local condition of tissue at fracture site, and vascular status of the extremity is important in planning the strategy and timetable of treatment. Also the delay from the injury to trauma unit has an effect on the treatment strategy (1, 2). The open fractures are usually classified using Gustilo system, I, II, IIIA, IIIB and IIIC (3). The treatment of severe compound fractures of the lower leg can be divided into 4 periods. 1) Acute treatment. 2) Soft tissue reconstruction 3) Bone reconstruction and 4) Correction of late problems.