Operative Treatment and Soft Tissue Management of Open Distal Tibial Fractures – Pitfalls and Results

被引:1
作者
Maximilian Faschingbauer
Jan Meiners
Arndt Peter Schulz
Klaus-Dieter Rudolf
Benjamin Kienast
机构
[1] BG Trauma Centre,Department of Traumatology, Orthopedics and Sports Medicine
[2] University of Lübeck,Department of Trauma and Orthopedics
[3] BG Trauma Centre,Department of Hand, Plastic and Microsurgery
[4] BG Trauma Centre,Department of Traumatology, Orthopedics and Sports Medicine
来源
European Journal of Trauma and Emergency Surgery | 2009年 / 35卷
关键词
Open fracture; Distal tibia; External fixation; Soft tissue management;
D O I
暂无
中图分类号
学科分类号
摘要
Open tibial fractures usually result from high-energy trauma. Severe soft-tissue injuries are often combined with open fractures of the distal tibia. A consecutive series of 42 patients with open extraarticular distal tibial fractures (Gustilo I–IIIc) operated on between July 2006 and February 2009 were included in the study reported here. We performed open reduction and internal fixation for the Gustilo I cases. Soft tissue was closed directly after antibiotic beads had been temporarily applied. For the Gustilo II and III cases, our treatment protocol included soft-tissue debridement of all devitalized soft tissue and bone fragments, pulsatile jet irrigation, and external stabilization. Soft tissue was temporarily closed with Epigard_ after the application of antibiotic beads. A second-look operation was scheduled after 3–5 days. Gustilo II patients needed an average of 1.1 (0–3) revisions until wound closure, compared to the average of 2.1 revisions necessary for the Gustilo III patients. It took 5.6 (0–16) days to obtain definitive wound closure in the Gustilo II patients and 9.9 (3–28) days in the Gustilo III patients. Skin grafting was sufficient for definitive softtissue closure in ten cases, local flaps in eight cases, and free musculocutaneous flaps were needed in six cases. Gustilo II patients with primary wound closure remained hospitalized for 11 days, while patients with secondary wound closure stayed in hospital for an average of 20 days. Our early results concerning infection rate, number of reoperations, and time to bony consolidation can be compared with other studies. Functional results will have to be evaluated at clinical follow-up.
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页码:527 / 531
页数:4
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