TITLE

Short-Term Outcomes of Severe Open Wartime Tibial Fractures Treated with Ring External Fixation

AUTHOR(S)
Keeling, John J.; Gwinn, David E.; Tintle, Scott M.; Andersen, Romney C.; McGuigan, Francis X.
PUB. DATE
December 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Dec2008, Vol. 90-A Issue 12, p2643
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The treatment of complex open tibial fractures sustained in combat remains controversial. This study investigated the short-term outcomes of type-III tibial shaft fractures treated at our institution with ring external fixation. Methods: A retrospective review identified sixty-seven type-III tibial shaft fractures in sixty-five consecutive patients treated between April 2004 and January 2007. Of these, forty-five tibiae in forty-three patients received fracture fixation with ring external fixation. The cases of thirty-six patients, who received treatment for thirty-eight tibial shaft fractures to completion with a standardized protocol, were reviewed. Results: A blast mechanism accounted for thirty-five injuries, and three injuries were from high-velocity gunshot wounds. There were twenty-one type-IIIA, thirteen type-IIIB, and four type-IIIC fractures. Rotational or free soft-tissue flap coverage was performed on fifteen patients. Eighteen patients received planned delayed bone-grafting, and nine had only bone morphogenetic protein placed at the fracture site at the time of final wound closure. All fractures healed with <5° of malalignment. One patient underwent elective delayed amputation. The average time to union with frame removal was 221 days (range, 102 to 339 days). Conclusions: Treatment of severe open wartime tibial fractures with a protocol-driven approach to wound management and placement of ring external fixation can result in a low rate of complications and a relatively high rate of fracture union. Most complications can be successfully managed without frame removal. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
36346492

 

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