Repair and reconstruction of severe leg injuries: retrospective review of eighty-five patients.
OBJECTIVE
To explore a good way of the reconstruction of severe tibial shaft fractures by using different flaps and external fixators.


METHODS
Eighty-five patients of Type IIIC tibial shaft fractures with average age of 42.5 years were treated in our hospital from 1990 to 2005. Injuries were caused by motorcycle accidents in 66 patients, by machine accidents in 16 patients, and by stone bruise in 3 patients. The management procedures consisted of administration of antibiotics, serial debridment, bone grafting if needed, application of different flaps, such as free thoracoumbilical flaps, fasciocutaneous flaps, saphenous neurocutaneous vascular flaps, sural neurocutaneous vascular flaps and gastrocnemius muscular flaps, and different external fixations, for instance, half-ring fixators, unilateral axial dynamic fixators, AO fixators, Weifang fixators, and Hybrid fixators. The average follow up was 6.3 years.


RESULTS
All flaps survived. Eighty-three cases had bone healed. The average bone healing time of different external fixations was 5.5 months in 47 cases with half-ring fixators, 9.2 months in 4 cases treated with unilateral axial dynamic fixators, 8.5 months in 6 cases with AO fixators, 10.7 months in 16 cases with Weifang fixators, and 7.8 months in 10 cases with assembly fixators. Except half-ring fixation, other fixations all needed necessary bone graft. Two cases treated with unilateral axial dynamic fixators had nonunion of bone and developed osteomyelitis. The wounds healed after the removal of the fixators and immobilization by plaster. The last follow up examination showed ankle and knee motion was normal and no pain was noted.


CONCLUSIONS
The combination of half-ring external fixators with various flaps provides good results for Type IIIC tibial shaft fractures.
Xu
Yong-qing
YQ
Orthopedic Center, Kunming General Hospital of Chengdu Military Command, Kunming 650030, China.
Lin
Yue-qiu
YQ
Li
Jun
J
Ding
Jing
J
Zhu
Yue-liang
YL
Ruan
Mo
M
Guo
Yuan-fa
YF
Wang
Xin-ming
XM
Xü
Xiao-shan
XS
Shi
Ji-hong
JH
Li
Chun-xiao
CX
Ma
Tao
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome