[Aggressive debridement and early soft tissue coverage of 3d degree open tibial fractures].
93 patients with grade III open tibial fractures were treated without a treatment protocol from 1980 to 1982. This group is compared to 147 pts. managed between 1983 to 1986 according to a standardized prospectively designed protocol with aggressive debridement augmented by pulsatile Jet-lavage. Serial debridement were performed at 48-hour intervales until early soft-tissue coverage were obtained using local or free muscle-flaps. The mean follow-up was 80 months respectively 44 months. --The aggressive regimen led to a statistically significant decrease in infection (30% vs 12%), nonunion (16% vs 6%), amputation (18% vs 6%) and combined hospitalization-periods (137 vs 74 days) [all p less than 0.001]. The aggressively treated groups showed a trend toward early fracture-healing (30 vs 23 weeks) although this was not statistically significant.
Ketterl
R L
RL
Chirurgische Klinik, Technischen Universität München.
Steinau
H U
HU
Feller
A M
AM
Stübinger
B
B
Claudi
B F
BF
D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000601:surgery; D013524:Surgical Flaps; D007507:Therapeutic Irrigation / Q000379:methods; D013978:Tibial Fractures / Q000601:surgery*
Aggressives Debridement und frühzeitige Weichteildefektdeckung bei drittgradig offenen Tibiafrakturen.