Staged management of open distal tibiofibular fracture in Lushan earthquake rescue

Abstract

Objective To characterize emergent treatment of open distal tibiofibular fractures in earthquake rescue in comparison with conventional medical treatment.Methods From 21 to 27 April,2013,we treated 12 patients with open distal tibiofibular fracture who had been injured in the earthquake at Lushan,Yaan,Sichuan,China.They were 5 men and 7 women,aged from 33 to 85 years (average,54.8years).By the Gustilo classification,there were 5 cases of type Ⅱ,4 cases of type ⅢA and 3 cases of type Ⅲ B.Two patients were complicated with ipsilateral closed fracture of the knee.Emergent debridement and external fixation with Hoffmann assembled fixator were performed for 11 patients while one patient received external fixation 5 days after injury.Secondary correction of the external fixation was conducted for those with poor alignment or ankle dislocation after primary management.Results Among the 11 patients receiving emergent debridement and external fixation,4 had satisfactory alignment of the lower limb but 7 did not.Of them,4 with mild injury of the soft tissue received direct correction of the alignment of the lower limb when the external fixation was changed while the other 3 with severe injury of the soft tissue or with ankle dislocation or fracture received secondary correction of the external fixation.Good alignment,good fracture reduction and perfect congruence of adjacent joints were achieved in all patients.Conclusions Open distal tibiofibular fractures can be treated quickly and efficiently using an assembled external fixator in earthquake rescue.Initial restoration of the limb alignment and congruence of adjacent joints are crucial and secondary adjustment of the external fixation is necessary for those with poor reduction in case their final treatment and functional recovery are affected by later transportation. Key words: Tibial fractures; Fibula; Fractures, open; External fixator; Earthquake