MANAGEMENT OF OPEN TIBIAL FRACTURES AT AYUB TEACHING HOSPITAL, ABBOTTABAD
Abstract
Background: Open fractures of tibia are usually caused by high-energy injury. Management of such injuries requirescare of contaminated soft tissue injury involving skin, muscles and neurovascular structures. Treatment of fracture,
which is badly comminuted and potentially contaminated, is always a problem. While limb salvage is the initial aim.
medium and long-term problems with soft tissue cover, infection and union are all too common and result in serious
disability. Methods: 32 open grade-111 tibial fractures were treated with AO (Arbeitsgemeinschaft fur
Osteosynthesefragen) tubular external fixator. The management and outcome were reviewed and tabulated. Results:
One out of 32 required primary amputation due to delayed vascular repair. The remainder received standardized wound
care consisting of surgical debridement and delayed closure of wound. Once the soft tissue envelope healed and
fracture was sticky external frame was removed and patella tendon bearing cast applied. In selected cases internal
Fixation was done (n=8, in 5 intramedullary nailing and in 3 plating). Nineteen cases were treated in PTB cast and 4
cases in external fixation till union. Deep infection rate was 13% and pin tract infection 10%. In 31 cases union was
achieved in 32 weeks (24 weeks to 62 weeks).
References
Gustilo. R B; Anderson .IT Prevention of infection in the
treatment of one thousand and twenty-five open fractures of
long bones, retrospective and prospective analysis. J. Bone and
Joint Surg (Am) 1976: 58-A: -453-58.
Gustilo R B; Mendoza R.M; Williams D.N. Problems in the
management of type-111 (Severe) open fractures. A new
classification of type-111 open fractions. J. Trauma 1984;
:792-96
Edwards CC; Simmons S.C; Browner B.D; Weigel M.C
Severe open tibial fractures Clin. Orthop 1988; 230:98-115.
Delinger E.P; Millr SD; Wertz MJ et al. Risk of infection after
open fracture of the arm or leg. Arch. Surg. 1988; 123:1320-
Gustilo R.B, Merkow RL. Templeman D. Current concept
review: The management of open fracture. J. Bone Joint Surg
AMO 1990; 72-A:299-304.
Byrd HB; Ciemey G; Tebbetts JB. The management of open
tibial fractures with associated soft tissue loss, external pin
fixation with early flap coverage. Plast reconstr Surg. 1981;
:73-79.
Yaremchuk MJ; Bfumback RJ; Manson PN et al. Acute and
definitive management of traumatic osteocutaneous defects of
the lower extremity. Plast Reconstr. Surg. 1987 ,80-114.
Gobal S, Majumder S; Batchelor AGB; Knight S.L; DeBoer
P; Smith RM Fix and flap, the radical orthopaedic and plastic
treatment of severe open fractures of tibia. J Bone & Joint
Surg. 2000; 82-B: 967-71.
Gustilo RB; Merkow RL; Templeman D. The management of
open fractures. B. Bone & Joint Surg 1999; 72-A:299- 304.
Hierholzer G; Rued TH; Allgower M; Schatzkerl J. Mannual
on the AO/AS1F Tubular external fixator. Springer-Verlog
Berlin. New York, Tokyo, 1985.
McGraw JB; Fishman JH; Sharzer LA, The verstile
gastroenemins myocutaneous flap plast and reconstr Surg.
;62:15-23.
Melendwz EM; Colon C. Treatment of open tibial fractures
with orthofix fixator. Clin. Ortho. 1989; 241: 224-230.
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