Primary vs secondary wound reconstruction in Gustilo type III open tibial shaft fractures: follow-up study of 35 cases.
OBJECTIVE
To compare primary and secondary wound reconstruction as a treatment method for Gustilo type III open tibial fractures.


METHODS
Thirty-five consecutive patients with a Gustilo type III open tibial shaft fracture were treated and followed up for 3 years. The patients were divided into two groups depending on the treatment protocol and timing of wound reconstruction: primary wound reconstruction (n=15) and secondary wound reconstruction (n=20). After determining median value, the variability was expressed with the 25th and 75th percentiles.


RESULTS
In the primary wound reconstruction group, healing was achieved in 13 out of 15 patients. The median time to recovery was 68 (25th-75th percentile=32-86) weeks, median number of operations was 4 (25th-75th percentile=3-5), and median Johner and Wruhs score was 4 (25th-75th percentile=3-5). There were 9 cases with a bone defect and 2 tibial amputations were performed. In the secondary wound reconstruction group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 115.5 (25th-75th percentile=70.0-128.5) weeks, median number of operations 7.5 (25th-75th percentile=6.5-8.5), and median score according to Johner and Wruhs' criteria 3 (25th-75th percentile=2-4). There were 19 cases with a bone defect and 1 tibial amputation was performed. Chronic osteomyelitis persisted only in a single patient. Median time to recovery and number of operations were significantly smaller in patients undergoing primary wound reconstruction.


CONCLUSIONS
Primary wound reconstruction required smaller number of operations and shorter time to recovery than secondary wound reconstruction, mostly due to a significantly smaller proportion of cases with a bone defect.
Stalekar
Hrvoje
H
Department of Surgery, Division for Traumatology, Rijeka University Hospital Center, Tome Strizica 3, 51000 Rijeka, Croatia. hstaleka@inet.hr
Fuckar
Zeljko
Z
Ekl
Darko
D
Sustić
Alan
A
Loncarek
Karmen
K
Ledić
Darko
D
D000328:Adult; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013978:Tibial Fractures / Q000601:surgery*