Early prophylactic autogenous bone grafting in type III open tibial fractures.
The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough débridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.
Department of Orthopaedics and Traumatology. Medicine Faculty of Dicle University, Diyarbakir, Turkey. ccevdet@dicle.edu.tr
Cumhur C
CC
Kesemenli
Ahmet
A
Kapukaya
Mehmet
M
Subaşi
Huseyin
H
Arslan
Serdar
S
Necmioğlu
Cuma
C
Kayikçi
D000328:Adult; D001858:Bone Nails; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome