Open Fractures Of Leg Research Articles

Massive bone defect in open leg fracture: A case report

Open fractures with massive defects are likely the most challenging conditions to manage in traumatology, particularly due to the scarcity of cases described in the literature where limb preservation was feasible. This report illustrates the management of an open fracture with a massive bone defect in which the physicians recurred to amputation after an attempt to preserve the patient’s quality of life through initial reparative treatment. A 57-year-old male presented with an open fracture with a de novo 25-cm bone defect following a motorcycle accident. Despite the large laceration, the injury presented with a relatively conserved surrounding muscular tissue; the distal two-thirds of the tibia were missing; yet, no neurovascular damage was documented. The patient was managed with a temporary external fixator and antibiotic-loaded cement spacer. Due to the patient’s desire to ride his motorcycle again, the authors performed a custom-made tibiotalar nailing arthrodesis 22 weeks later. This case presented the risk of infection and low quality of life, which led to amputation 74 weeks after the nailing procedure was performed. The treatment remains challenging in cases of massive bone defects and a relatively preserved biological-functional environment, and efforts should be made to develop tailored strategies. Although individualized care provides patients with time and hope, it might still fail to guarantee a decent quality of life and risks being a temporary solution before reverting to amputation.

Methods of bone fixation and skin loss coverage in open leg fractures in precarious area

Methods of bone fixation and skin loss coverage in open leg fractures in precarious area

Tibio-Fibular Fusion by Posterolateral Approach to Treat Nonunion of Tibia

A 30- year- old male has sustained open fracture of left leg and undergone 4 surgeries for four years (1. debridement and external fixator, 2. removal of external fixator, 3. vascularized contrafibular autograft plus change new plate/screws of ipsifibula, 4. flap surgery to cover the wound). At the time of examination: unability to walk, abnormal movements of leg, tibial bone loss 8 cm, especially the soft tissue of almost total anterior leg was so bad: no more subcutaneous tissue, skin very next to bone decouraging any attempt anterior approach. Diagnosis: pseudarthrosis of left leg with tibial large bone loss in the status of seriously damaged soft tissue of anterior leg surface. Technique operation chosen: Posterolateral. Appoach, Tibiofibular Fusion with massive autocancellous bone graft harvested from posterior iliac pelvis. Casting 4 months (from midthigh to metatarsal head). Postoperative walking with two crutches, Full Weight Bearing allowed after 14 weeks. Removal of cast after 16 weeks. Full knee flexion obtained 8 weeks after cast removal. Review at tenth month: normal walk, slight running, complete knee Range of Motion, 5. degree loss of dorsiflexion of ankle. X-rays: good fusion proximal and distal tibiofibular spaces and partly fusion the tibio-tibial gap. By this case,we can resumably conclude Tibiofibular Fusion through Posterolateral Approach should be strongly indicated for the leg nonunion in which the soft tissue of anterior surface is not favorable for nearby approach.

Stress-Induced Hyperglycemia is a Risk Factor for Surgical-Site Infections in Nondiabetic Patients with Open Leg Fractures.

Nondiabetic patients with open leg fractures who have elevated blood glucose levels on arrival in the emergency department have an increased risk of surgical-site infections (SSIs). This study evaluates the association between the incidence of SSIs in nondiabetic patients with an open leg fracture and blood glucose levels registered on arrival in the ER. We also analyzed the correlation between patients' days of hospital stay and the incidence of SSIs and the time elapsed between the damage control with external fixation and final fixation and the incidence of SSI. We retrospectively studied nondiabetic patients admitted to our emergency unit from 2017 to 2021 with a diagnosis of open leg fracture consecutively treated. Based on the diagnosis of SSIs, all enrolled patients were divided into two groups based on the developed (group A) or not developed (group B) SSIs within 1 year after surgery. All patients enrolled in the study underwent damage control within 24 hours after admission to the ER. At stabilization of general clinical and local wound conditions, all patients underwent definitive surgery. We enrolled 80 patients. In group A, glycemia on arrival in the ER was on average 148.35 ± 19.59 mg/dl, and in group B, it was 122.61 ± 22.22 mg/dl (p value: 0.0001). In group A, glycemia in the first postoperative day was on average 113.81 ± 21.07 mg/dl, and in group B, it was 99.02 ± 17.60 mg/dl (p value: 0.001). In group A, the average hospitalization was 57.92 ± 42.43 days, and in group B, it was 18.41 ± 14.21 days (p value: 0.01). Through Youden's J, we therefore analyzed the value with the highest sensitivity and specificity which proved to be 132 mg/dl. Our findings show that nondiabetic patients with SIH have a significantly increased risk of SSIs compared to patients without SIH within 1 year after surgery. Patients with open leg fractures with SIH have a significantly higher average hospital stay than patients without SIH. Further studies are needed to confirm 132 mg/dl of blood glucose levels as a value to stratify the risk of SSIs in these patients.

Price for Care of Open Fractures of Limbs in the Surgical Emergency of the Brazzaville Hospital and University Center

Introduction: The aim of this work was to describe the emergency management of open fractures at the Brazzaville University Hospital (CHUB). Patients and Methods: this was a descriptive study with retrospective data collection from January 1 to December 31, 2022, in the surgical unit of the medical-surgical emergency department of the CHUB. All injured people hospitalized during the study period for recent open fractures whose initial treatment was carried out at the CHUB were included. The parameters studied were epidemiological, clinical, paraclinical and therapeutic. The GUSTILO Anderson Classification was used to assess the extent of skin lesions. Results: We collected 114 patients for 121 open fractures. There were 93 men (81.57%) and 21 women (18.43%), i.e. a sex ratio of 4.42. The average age was 32.4 ± 6.23 years, the etiologies were dominated by public road accidents (73.68%). The average consultation time was 4.45 hours. The pelvic limbs were affected in 80.99% of cases. Open fractures of both leg bones were the most frequent (75.20%). Type II fractures of the GUSTILO classification were in the majority (69.42%). There was one case of vascular involvement of the leg tripod and one case of radial nerve involvement. The average time for initial treatment was 8.36 ± 1.20 hours. Types I and II lesions required emergency suture before definitive treatment in 14.87% and 46.28% of cases respectively. The average time for definitive treatment was 22.91 hours. Osteosynthesis was performed in 86.78% of cases, cast immobilization with fenestration in 12.39% of cases and transfemoral amputation in 1 case. Internal fixation using an external fixator was the most frequent surgical indication (68.59%). Conclusion: Open leg fractures are very common traumatic injuries in our daily practice. Surgical treatment with an external fixator is the most commonly performed.

Combined Orthoplastic Approach in the Treatment of Open Fractures of the Leg Bones: a Review of the Literature

Open fractures of the lower leg bones with a concomitant soft tissue defect is a rather serious problem in traumatology and orthopedics, as well as in reconstructive surgery. Traditionally, in our country and the CIS countries, with this type of fracture, external fixation is used - transosseous distraction osteosynthesis with the Ilizarov apparatus; often practiced late final closure of the skin defect. Currently, the combined orthoplastic method of treating open fractures of the lower leg is gaining popularity all over the world, which involves osteosynthesis of the fracture and skin plasty of the soft tissue defect of the limb in one stage within 72 hours after the injury, which will significantly reduce the time of treatment of the patient, as well as reduce the risks infectious complications.The purpose of this review article is to study research in the international scientific community on the combined use of traumatology and plastic surgery methods in the treatment of open fractures of the lower leg with an accompanying soft tissue and skin defect, to compare the results of treating this type of injury with an orthoplastic approach and traditional orthopedic, as well as the advantages and disadvantages various methods of osteosynthesis. An information search was carried out for scientific articles in the PubMed, Web of Science, Cochrane, Wiley, Cyberleninka databases, using the keywords “open fracture of the lower leg”, “orthoplastic method”, “Ilizarov apparatus”, “skin plasty”. We analyzed 58 articles published between 1997 and 2022, including information on the epidemiology of open tibial fractures, issues and methods of treating open tibial fractures, and preventing post-traumatic and postoperative complications. This article includes the results of 2 large systematic reviews, 4 meta-analyses, 1 randomized controlled trial (RCT), 2 prospective cohort studies, 2 retrospective cohort studies, and UK and US guidelines.The study concluded that the orthoplastic approach was successful and its advantages over the classical approach in the treatment of open fractures of the lower leg bones, expressed in the reduction of treatment time, optimization of care for patients with open fractures of the lower extremities. In addition, according to reports of various scientific studies, the orthoplastic approach also gives good results in terms of reducing the risk of post-traumatic complications in patients and improving the functional outcome of the injured limb.Key words: combined orthoplastic approach, open fracture of the leg bones, reconstructive surgery.

Secondary intramedullary nailing for open tibial shaft fractures. Comparison of a one-stage versus two-stage surgical procedure

IntroductionThe objective of this study was to compare the rates of radiological and clinical complications after sequential treatment of a tibial shaft fracture by external fixation followed by secondary nailing with an early-stage conversion (C1S) versus a two-stage late conversion (C2S). The hypothesis of this work was that treatment with C1S does not increase the risk of surgical site infections compared to C2S, and allows faster healing with a lower malunion rate. Material and methodsWe carried out a retrospective and comparative study based on the files of the traumatology department of the Édouard Herriot University Hospital in Lyon. We reviewed the records of patients who presented with a Gustilo grade 1, 2 or 3a open tibial fracture treated with external fixation with conversion by intramedullary nailing within 6 months from January 2010 to December 2020. We assessed the occurrence of Surgical Site Infections (SSI), consolidation time, time until resumption of weight bearing and the malunion rate. ResultsOf the 55 patients included, a C1S procedure was performed in 25 cases (45.5%) versus 30 cases (54.5%) for C2S. No significant difference was found concerning the occurrence of SSI after intramedullary nailing between the two groups (p=0.81). A significant difference was observed in terms of bone healing (p=0.036) and the malunion rate (0.0013) in favor of nailing in one stage. DiscussionThe strategy of converting an open leg fracture early, in one stage (C1S), after initial external fixator placement allows for faster healing and weight bearing, while ensuring a lower malunion rate compared to that of a late two-stage conversion. In the absence of a scar at the time of intramedullary nailing, C1S does not increase the risk of surgical site infections. While the choice of a late and sequential two-stage operation is likely related to the surgeon's apprehension around conversion of an open leg fracture by intramedullary nailing, this study could promote the use of C1S in a greater number of situations. Level of evidenceIV.

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Introduction: Prevention of infection remains the critical goals in open fracture treatment. This study reports the epidemiological, clinical and therapeutics features at Lubumbashi teaching hospital.Methods: the study covers a three-year period, including retrospective study from January 2018 to December 2020. Data collection was performed through a standardized survey form included many parameters.Results: 44 cases of open leg fractures were registered in 42 patients, this represented 2.46% in orthopedics and traumatology department and 5.92% in surgery. The most common age brackets were 20- 29 years (65.91%). The mean age (33.41years) ranging from 8 to 80 years. Males accounted for 73.80% with a ratio sex M/F of 2.81. The most common etiology was traffic accidents (88.64%). Mostly the mechanism was direct (81.82%); 73.80% of patients arrived within 6 hours. Clinical sign mostly represented were deformation of the leg (95.46%). Most of fracture was classified in Cauchoix 2 (45.45%) with head injury like most associated injury (34.10%). Radiologically, the fracture line through the bone was oblique in 38.64% of cases and transverse in 29.55%. 38.64 % of open leg fractures occur in the middle third of the bone in our study. Definitive treatment consisting in putting a plaster window (18.18%) and external fixation (40.90% of cases).Conclusion: open leg fracture is an almost daily practice which the management must be delicate.Mots clés: fracture ouverte – jambe – épidémiologie - prise en charge.

To evaluate the role of VAC therapy in open fractures after primary fixation in term of faster and more effective wound healing

Vacuum-assisted closure (VAC) is a noninvasive, active wound management system that exposes a wound bed to local sub atmospheric pressure, removes fluid from the extravascular space, improves circulation, and enhances the proliferation of granulation tissue. The purpose of this study is to know the rate of wound infection, number of days required for making the wound fit for skin cover procedures, number of days required for formation of uniform granulation tissue bed in the wound healing treated by Vacuum Assisted Closure after primary fixation of fracture.Patients between 18 to 60 years were included in this prospective randomized controlled trial. Primary internal Fixation of fracture was done as soon as possible followed by VAC application. Functional outcome of cases recorded during each follow up according to Johner and Wruh’s (1983).According to this study, 30 patients with open fractures of both bone leg after primary internal fixation with VAC application. During follow up effective decrease (mean ± SD) in wound size after VAC therapy was 9.97±9.59 cm2 with P-value 0.0481. This technique has resulted in the effective decrease in wound size, infection and give a better functional outcome.The greatest advantage of VAC was found to facilitate rapid formation of granulation tissue on wounds with exposed tendons, bones, raw area wounds and exposed implants hence decrease healing time and minimize soft tissue defect coverage procedures.

SOFT TISSUE RECONSTRUCTION IN SEVERE OPEN LEG FRACTURE

Methodology Eighteen patients who sustained severe open leg fractures (Gustilo’s III) were treated, average age of 25years. Aims of study:The project is to evaluate: the benet of early over late soft tissue reconstruction in severe open leg fractures (Gustilo type III) regarding the ap and bone healing. All patients were treated by meticulous wound excision with stabilization of fracture and then wound cover, which is done early in 6 patients (before 7 days) and late in 12 patients (after 7 days). local muscle ap was done in 9 patients (50%), local fasciocutanous ap in 6 patients (33/3%) and free ap in 3 (16.7%). CONCLUSION: primary reconstruction of Gustilo type III open tibial fractures had advantages compared with secondary reconstruction. Smoking plays an important role in increasing complication.

Simultaneous, Asymmetrical, Comminuted and Bilateral Ballistic Fractures by Multiple Gunshot Wounds and a Review of Its Literature: A Case Report in Chad

Although open leg fractures are very common in orthopedics and traumatology, bilateral open leg fractures are extremely rare and are usually associated with an increased risk of complications. We report a case of a simultaneous, asymmetrical, comminuted and bilateral open fracture of the tibia and fibula by a firearm that occurred during an escape attempt in a 29-year-old prisoner. The pre-operative radiological assessment found an open fracture of both legs of the ballistic type; multiple traumatic gunshot wounds with a narrow entry hole and a wide exit hole. Early surgical intervention of intravenous antibiotics, tetanus prophylaxis and open fracture irrigation and debridement was performed within the 6 hour rule. The treatment consisted of a posterior splint followed by trimming andosteosynthesis using a FESSA external fixator from the military health service. A second operation was not needed. Evolution was favorable with ambulation starting from the 45th day. Simultaneous and bilateral tibia-fibula fractures by a firearm are exceptional, therefore, the treatment was surgical with the pre-operative and post-operative protocols well managed.

1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures

Abstract Introduction Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures. Method 214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death). Results Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p > 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications. Conclusions Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.

Application of MALDI-TOF MS Profiling Coupled With Functionalized Magnetic Enrichment for Rapid Identification of Pathogens in a Patient With Open Fracture.

Posttraumatic infections can occur in orthopedic trauma patients, especially in open fractures. Rapid and accurate identification of pathogens in orthopedic trauma is important for clinical diagnosis and antimicrobial treatment. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully used for first-line identification of pathogens grown on culture plates. However, for direct analysis of liquid clinical specimens, pre-purification of the sample is necessary. Herein, we investigated the feasibility of coupling Fc-MBL@Fe3O4 enrichment with MALDI-TOF MS profiling in the identification of pathogens in liquid-cultured samples. This method is successfully used for the identification of pathogens in a patient with an open-leg fracture obtained at sea. Pathogens were enriched by Fc-MBL@Fe3O4 from briefly pre-cultured liquid media and identified by MALDI-TOF MS. We identified an opportunistic pathogen, Vibrio alginolyticus, which is uncommon in clinical orthopedic trauma infection but exists widely in the sea. Therefore, combining Fc-MBL@Fe3O4 enrichment and MALDI-TOF MS profiling has great potential for direct identification of microbes in clinical samples.

Clinical Study of Functional Outcome of External Fixator Device as a Primary Definitve Treatment of Open Tibia Fracture

Background: Open fractures of leg are quite common in Road traffic accidents. The ideal protocol for openfractures of leg is initial thorough debridement, soft tissue coverage and intramedullary nailing or externalfixator application. External fixator may be later converted to internal fixation with reamed or unreamedintramedullary nail or left as a definitive treatment.Methodology: This prospective study was conducted at Rohilkhand Medical College And Hospital fromJanuary 2019 to January 2020 on patients presenting with open tibial fracture. Tubular External Fixator wasused. Total 30 patients were enrolled in this study.Results: In our study 30 patients were included in which 20 were male and 10 were females with meanage 32.2 years including children and elderly age group there was no age bar. Mean operative time was 60minutes. Average time for union was 24 weeks.Conclusion: External fixation as a primary definitive treatment for open tibial fracture is a cost effectiveprocedure in developing country with minimal morbidity and mortality.

Sideswipe Injury to the Leg – A Hefty Price for an Autorickshaw Ride: A Case Report

Introduction: Sideswipe injury is often described as a complex elbow injury occurring when the elbow rests on a side bar of the window of a vehicle and is then impacted by another vehicle travelling in the same or opposite direction. Side swipe injury to the leg is uncommon. Although the term side swipe is mostly used for elbow injuries, we came across a case of open comminuted fibular fracture of right leg resulting from side swipe while travelling in a tricycle. Case Presentation: A 27-year-old male presented to us after sustaining an injury to his right leg while he was travelling in a tricycle with his right leg protruding out. There was an open wound of size 20 cm x 10 cm on lateral aspect of the middle one-third of his right leg and x-rays revealed a comminuted fracture of mid shaft of fibula. He was managed with debridement, vacuum assisted closure (VAC) dressing, split thickness skin grafting and plaster immobilization. At one year follow-up, the patient had excellent function in the leg with no activity limitation and just a minor loss of power in eversion. Conclusion: Sideswipe injury of the leg is an infrequently reported entity and can occur if the leg is protruding out while riding in a tricycle (autorickshaw). Keywords: Leg, Sideswipe injury, Tricycle related injury.

Emergency Intramedullary Nailing in Open Leg Fractures: What Results?

Introduction: Leg fractures are the prerogative of violent trauma, which lead to pluritissular lesions, including the opening of the focus, thus worsening the prognosis. The indication of centromedullary nailing (CMN) is subject to time and trained team requirements. The aim of this work is to evaluate the results of CMN in emergency cases of open leg fractures in adults. Patients and Methods: This was a retrospective, descriptive and analytical study from January 1, 2014 to December 31, 2018. It concerned adult patients with an open leg fracture treated by CMN in emergency at the Orthopedics-Traumatology Department of the Yalgado Ouedraogo University Hospital. During five years, 91 patients were registered. Their average age was 34.1 years with a sex ratio of 2.2. The average admission time was 1 hour 41 minutes. Cauchoix and Duparc type I open fractures predominated (64.8%). Antibiotic therapy was instituted as soon as the patient arrived. The functional results of osteosynthesis were evaluated according to the Lysholm score after an average follow-up of 48 months. Results: The majority of our patients (51.3%) were operated on between the 6th and 18th hour. After careful trimming of the open fracture, CMN was performed in all our patients. The average hospital stay was six days. The mean Lysholm score was 87.23 ± 11.06 with a satisfactory functional result in 81.3% of cases. Discussion: The satisfactory results observed in 81.3% of our study testify to the reliability of the indication of CMN as specified by Dakouré et al. [4] in their series. Conclusion: Open leg fractures are very frequent injuries and have a considerable socio-economic impact. Centromedullary nailing is a suitable solution for adequate and rapid socio-professional reintegration of the patient.

A study of clinical outcome and patient quality of life in timing of free flap cover in type IIIB open fractures

Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while 7 others had sub flap collections and partial flap necrosis. Duration of hospitalization was significantly lower in early flap cover group. PQOL measured with EQ-5D (EuroQol 5D) was significantly higher in the early flap covers.Conclusions: From our study we concluded that timing of free flap cover positively influenced clinical outcome of reduced hospitalization, although there was no relation of timing of free flap to flap or bone complications. The functional outcome measured by PQOL was significantly higher in patients who had microvascular reconstruction early.

One-stage repair of soft tissue defects in open leg fracture

Objective To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap. Methods From January 2011 to January 2018, 34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics, The Second Affiliated Hospital to Harbin Medical University. They were 31 males and 3 females, aged from 13 to 54 years(average, 35 years). According to the Gustilo classification, the defects were type ⅢA in 31 cases and type ⅢB in 3 cases. The wound size ranged from 6 cm×3 cm to 25 cm×10 cm. All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement. Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients. All defects were repaired with a free anterolateral thigh flap. Flap survival, vascular crisis and bone infection were followed up postoperatively. Results All the free flaps survived in the 34 cases with no vascular crisis. These patients were followed up for 6 months to 3 years (average, 10 years). The flaps healed well, with good appearance and soft texture. No bone infection occurred at the defective sites. After postoperative rehabilitation, the knee extension ranged from 160° to 180°, knee flexion from 90° to 110°, ankle dorsal extension from 90° to 110°, and ankle plantar flexion from 100° to 120°. Conclusion Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation, because the primary wound healing can avoid infection and lead to fine survival of the flap. Key words: Fractures, open; Soft tissue defects; Surgical flaps; Reconstructive surgical procedures; Legs

Induced membrane technique and microsurgery for open leg fractures of Gustilo types IIIB-C

Objective To evaluate the induced membrane technique combined with microsurgery for repair of open leg fractures of Gustilo types ⅢB-C. Methods This retrospective study reviewed 15 patients who had been treated for open leg fractures of Gustilo types ⅢB and ⅢC by the induced membrane technique and microsurgery between January 2015 and January 2017 at Institute of Orthopedics, 920 Hospital, The Joint Logistic Service of The People’s Liberation Army. They were 10 men and 5 women, aged from 18 to 41 years(average 32 years). There were 9 cases of Gustilo type IIIB and 6 ones of Gustilo type IIIC. After thorough debridement, the fractures were reduced and fixated temporarily using external frames. The bone defects were filled with antibiotic bone cement to induce biofilm formation. After necessary reconstruction of limb structures, including neurovascular repair and transposition of tendon and nerve, crucial soft-tissue wounds were covered with surgical flaps. In the secondary surgery 6 to 8 weeks later, with the external frames replaced by internal fixation or not, the bone cement was removed without damaging the biofilm before graft reconstruction with autogenous cancellous bone. Results The 15 legs were all salvaged successfully. The in-hospital time ranged from 21 to 39 days (mean, 29 days). Crucial wounds were repaired primarily without any severe or persistent infection. Follow-ups ranged from 12 to 24 months (average, 15 months). Bone union time ranged from 10 to 17 months (average, 11.2 months) with satisfactory aesthetic and functional recovery of the leg. Conclusion Reconstruction of open leg fractures of Gustilo types Ⅲ B-C with induced membrane technique and microsurgery can result in decreased therapeutic duration, reduced complications and positive outcomes. Key words: Fractures, open; Surgical flaps; Microsurgery; Leg; Induced membrane technique

Transplantal distal migration of a tibial küntscher nail: About a case at Sylvanus Olympia hospital of lime

Open leg fractures are a therapeutic challenge because of the complexity of the initial management, the poor choice of immediate immobilization, and the difficult treatment of infectious and bone complications. The use of the kuntscher nail in open fractures ensures precarious stability of the fracture site, and exposing it to complications. We report the case of a trans-plantar distal migration of a kuntsctcher nail in a 43-year-old patient operated 11 years earlier for open leg fracture. Management consisted of nail removal, and treatment of infectious complications. Trans-plantar distal migration of the kuntscher nail is a rare but possible complication. It is favored by bone infection and contributes to the maintenance of the infection. The removal of the nail should be done as soon as possible and replaced with a more stable material if necessary.