[A turning point in the therapeutic history of open leg fractures: osteosynthesis coupled to the immediate dressing in the presence of major damage to the soft tissues].
A brief history of the treatment of open leg fractures (OLF) points out the problems posed by the present therapy with regard to the soft tissues in the most serious cases (type III from cauchoix, Duparc, type III A and B from Gustilo). Which strategy should be foremost, knowing that the debridement, stabilization and cover are the three essential procedures? Rigorous debridement certainly carries unanimous approval but some are opposed to this procedure during the first few days. Also widely recognized is the beneficial aspect of early cover when regarding aseptic evolution, consolidation, low rate of complications, rehabilitation and the patient's helplessness. However, despite the well demonstrated results of BYRD [14] and GODINA [15] and because of the debridement concept and logistical insufficiencies, thorough treatment in a true emergency has not achieved full acceptance. In general, the majority of surgeons first clear, stabilize with the use of an external fixator in true emergency situations and cover several days later. For the past ten years, in real emergencies, in the Department of Orthopedics, Traumatology and Plastic Surgery at the Besançon University Hospital Center we have subscribed to a radical treatment which simultaneously combines debridement, osteosynthesis (locked centro-medullary nailing) and cover with the use of free flaps in the same operating period. A study based on 27 wounded patients seeks to validate the advantages of looked centro-medullary nailing over the use of an external fixator and the use of free flaps rather than local flaps in the most serious cases.
Vichard
P
P
Service de Chirurgie Orthopédique, Traumatologique et Plastique, C.H.U.-Hôpital Jean Minjoz, Besançon.
Tropet
Y
Y
Garbuio
P
P
D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*
Un tournant dans l'histoire thérapeutique des fractures ouvertes de jambe (FOJ): l'ostéosynthèse couplée à la couverture immédiate en présence de dégâts majeurs des parties molles.