The tibial bayonet method of wound closure

Peter O'Farrell,Annette-Christi Barnard,Franz Birkholtz

doi:10.1007/s11751-018-0304-3

Peter O'Farrell, Annette-Christi Barnard + Show 1 more

Open Access

https://doi.org/10.1007/s11751-018-0304-3

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Abstract

Management of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed ‘bayonet apposition’ allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradually distracting the bone segments once the soft tissues have healed. This is facilitated with a hexapod fixator for stabilization of the fracture and distraction. Prerequisites for utilizing this method are circumferential soft tissue damage to the lower limb with viable distal tissue. The bayonet method allows primary closure of a wound and rapid restoration of the native length of the limb.

Highlights

Compound tibial fractures are severe limb-threatening injuries and can result in high patient mortality and protracted hospital care
Soft tissue cover lowers infection rates by converting an open fracture to a closed one and has resulted in this ‘fix and flap’ concept being widely accepted as the preferred standard of care for compound tibias [2,3,4,5,6]
The resultant higher morbidity in open fractures with delayed closure is well documented in the literature with infection rates up to 44% [8, 9]

Summary

Introduction

Compound tibial fractures are severe limb-threatening injuries and can result in high patient mortality and protracted hospital care. Keywords Limb salvage · Compound tibial fractures · Hexapod-assisted closure · Bayonet method · Duplication Soft tissue cover lowers infection rates by converting an open fracture to a closed one and has resulted in this ‘fix and flap’ concept being widely accepted as the preferred standard of care for compound tibias [2,3,4,5,6].

Results

Conclusion