title: Bone debridement and limb lengthening in type III open tibial shaft fractures: no infection or nonunion in 9 patients.
abstract: We retrospectively reviewed a consecutive series of 9 patients with tibial shaft fractures and extensive soft tissue damage, who had completed treatment by means of bone resection and distraction. 4 patients had type IIIB fractures and 5 type IIIC. The median follow-up time after bone resection was 27 (12-43) months. All patients were treated with debridement of devitalized soft tissue and resection of dead bone at the fracture site. The median bone shortening was 4 (3-9) cm. Equal limb-length was restored by proximal corticotomy and lengthening. A free vascular flap in 5 patients and a local flap in 4 patients corrected the soft tissue loss. All soft tissue transfers were successful, except in 1 case, which healed after a new free flap was made. The median union time of the fracture was 8 (4.5-28) months from the injury and 7 (3-10) months from the time of bone resection. There were no deep infections or nonunions and no secondary amputations. This series shows that bone debridement and limb lengthening, with a multidisciplinary approach, is often successful in salvaging limbs at high risk of amputation.
authors.affiliation: Department of Orthopedics, Sahlgrenska University Hospital/Göteborg University, Sweden. hans.granhed@orthop.gu.se
authors.forename: H P
authors.initials: HP
authors.lastname: Granhed
authors.forename: A H
authors.initials: AH
authors.lastname: Karladani
mesh_terms: D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects / Q000379:methods*; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D017102:Fracture Healing; D005597:Fractures, Open / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome