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 seriousdisability. Methods: 32 open grade-111 tibial fractures were treated with AO (Arbeitsgemeinschaft furOsteosynthesefragen) 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 woundcare consisting of surgical debridement and delayed closure of wound. Once the soft tissue envelope healed andfracture was sticky external frame was removed and patella tendon bearing cast applied. In selected cases internalFixation was done (n=8, in 5 intramedullary nailing and in 3 plating). Nineteen cases were treated in PTB cast and 4cases in external fixation till union. Deep infection rate was 13% and pin tract infection 10%. In 31 cases union wasachieved in 32 weeks (24 weeks to 62 weeks).