|
The Journal of Bone and Joint Surgery, Vol 73, Issue 9 1316-1322, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury
MD Fischer, RB Gustilo and TF Varecka
Orthopaedic Surgery Department, Hennepin County Medical Center, Minneapolis, Minnesota 55415.
The cases of forty-three patients who had a Type-IIIB open fracture of the
tibial shaft were reviewed to determine the effect of treatment of the
soft-tissue injury on the rate of major complications. An infection
developed in two of the eleven patients who had had early muscle-flap
coverage compared with ten of the nineteen who had been managed by open
care of the wound and nine of the thirteen who had had later flap coverage.
Patients who had had bone-grafting after complete re-epithelialization of
the wound, regardless of the method of closure, had a lower rate of early
infection (none of sixteen compared with four of fifteen) and an earlier
average time to union (fifty-four compared with sixty-three weeks) than
those in whom the wound was not completely closed or was draining at the
time of bone-grafting. Delayed intramedullary nailing with reaming was
associated with a high rate of infection (nine of nineteen patients),
regardless of the condition of the soft tissue at the time of nailing. In
our opinion, adequate debridement and early assessment of the soft-tissue
defect are necessary so that appropriate soft-tissue coverage can be
provided within the first one to two weeks. When the soft-tissue portion of
the injury is addressed promptly and definitively and then allowed to heal
completely, secondary osseous reconstruction may proceed with fewer
complications.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
L. K. Cannada, J. O. Anglen, M. T. Archdeacon, D. Herscovici Jr., and R. F. Ostrum
Avoiding Complications in the Care of Fractures of the Tibia
J. Bone Joint Surg. Am.,
August 1, 2008;
90(8):
1760 - 1768.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. G. Zalavras, R. E. Marcus, L. S. Levin, and M. J. Patzakis
Management of open fractures and subsequent complications.
J. Bone Joint Surg. Am.,
April 1, 2007;
89(4):
884 - 895.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. C. Breugem and S. D. Strackee
Is There Evidence-Based Guidance for Timing of Soft Tissue Coverage of Grade III B Tibia Fractures?
International Journal of Lower Extremity Wounds,
December 1, 2006;
5(4):
261 - 270.
[Abstract]
[PDF]
|
|
|
|
|
|
|
K. Okike and T. Bhattacharyya
Trends in the Management of Open Fractures. A Critical Analysis
J. Bone Joint Surg. Am.,
December 1, 2006;
88(12):
2739 - 2748.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Sherman, S. Rahban, and A. N. Pollak
Timing of Wound Coverage in Extremity War Injuries
J. Am. Acad. Ortho. Surg.,
September 1, 2006;
14(10):
S57 - S61.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. V. Giannoudis, C. Papakostidis, and C. Roberts
A review of the management of open fractures of the tibia and femur
J Bone Joint Surg Br,
March 1, 2006;
88-B(3):
281 - 289.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. B. Naique, M. Pearse, and J. Nanchahal
Management of severe open tibial fractures: THE NEED FOR COMBINED ORTHOPAEDIC AND PLASTIC SURGICAL TREATMENT IN SPECIALIST CENTRES
J Bone Joint Surg Br,
March 1, 2006;
88-B(3):
351 - 357.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. DeCoster, R. J. Gehlert, E. A. Mikola, and M. A. Pirela-Cruz
Management of Posttraumatic Segmental Bone Defects
J. Am. Acad. Ortho. Surg.,
January 1, 2004;
12(1):
28 - 38.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. G. Zalavras and M. J. Patzakis
Open Fractures: Evaluation and Management
J. Am. Acad. Ortho. Surg.,
May 1, 2003;
11(3):
212 - 219.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. Pollak, M. L. McCarthy, and A. R. Burgess
Short-Term Wound Complications After Application of Flaps for Coverage of Traumatic Soft-Tissue Defects About the Tibia
J. Bone Joint Surg. Am.,
December 1, 2000;
82(12):
1681 - 1681.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
S. A. OLSON
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Open Fractures of the Tibial Shaft. Current Treatment*{{dagger}}
J. Bone Joint Surg. Am.,
September 1, 1996;
78(9):
1428 - 37.
[Full Text]
|
|
|
|
