External fixation in the treatment of severe tibial fractures complicated by soft tissue injury.
Background. In recent years multiple injuries to the tibial shaft have become increasingly common. High-energy impacts cause comminuted fractures, often accompanied by damage to neural and vascular structures, muscle, and surface layers. The key to good healing is preserving normal blood supply. Serious damage to the tibia should be treated by external stabilization. Material and methods. A group of 23 patients with severe tibial fractures accompanied by soft-tissue injures were treated surgically, using Polfix, Ilizarov and Dynastab external stabilizers. Open fractures were classified according to the Gustillo-Anderson scale. Internal bone transport and the Ilizarov apparatus were used for the treatment of fractures with bone defect. Bone infections were treated with targeted antibiotic therapy and flush drainage. In cases with staphylococcus infection anti-vaccination was used. Plastic surgery was performed to cover soft tissue defects. Polfix stabilizers were removed after 35 weeks, Ilizarov after 45 weeks, and Dynastab after 18 weeks. The Sarmiento cast was applied in 6 cases. Results. In all patients treated with external fixation good results we observed. Conclusions. In the treatment of open tibial fractures complicated by significant bone defects and soft-tissue defects (type IIIB/C), the methods of choice are Ilizarov or Dynastab stabilizers. Polfix or Dynastab stabilizers are suitable for open fractures of types I-IIIA. Serious tibial injury necessitates the use of various kinds of skin grafts, so the best solution is regular cooperation with a plastic surgeon. Treatment with Sarmiento's functional plaster cast is a valuable supplement to external fixation.
Maciej
M
Słuzałek
Tadeusz S
TS
Gaździk
Stanisław
S
Mrozek
Jan
J
Ryba