MANAGEMENT OF OPEN TIBIAL FRACTURES AT AYUB TEACHING HOSPITAL, ABBOTTABAD

Authors

  • Shahid Sultan
  • Ali Asghar Shah

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).

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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