title: A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia.
abstract: BACKGROUND
  The question of whether to recommend amputation or salvage after type IIIB and IIIC tibial fractures remains unanswered. The purpose of this study was to conduct a systematic review to derive evidence-based recommendations concerning primary amputation versus limb salvage for type IIIB and IIIC open tibial fractures.
  
  
  METHODS
  Articles from Medline, Cinahl, and Embase that met predetermined criteria were included. Outcomes of interest included length of hospital stay, complications, rehabilitation time, quality of life, limb function, pain, and return to work data. Pooling of statistical data was performed when possible.
  
  
  RESULTS
  The authors reviewed 1947 articles, and 28 observational studies were included. Length of hospital stay was 56.9 days for salvage patients and 63.7 days for amputees. The most common complications after salvage attempt were osteomyelitis (17.9 percent), nonunion (15.5 percent), secondary amputation (7.3 percent), and flap failure (5.8 percent). Rehabilitation time for salvaged patients was reported as time to union (10.2 months) and time to full weight-bearing (8.1 months). Pain, quality of life, and limb function outcomes were assessed differently among studies and could not be combined. The proportion of patients who returned to work was 63.5 percent for salvage patients and 73 percent for amputees.
  
  
  CONCLUSIONS
  The current literature offers no evidence to support superior outcomes of either limb salvage or primary amputation for type IIIB and IIIC tibial fractures. When outcomes are similar between two treatment strategies, economic analysis that incorporates cost and preference (utility) may define an optimal treatment strategy to guide physicians and patients.
authors.affiliation: Ann Arbor, Mich. From the University of Michigan Medical School, the Center for Statistical Consultation and Research, University of Michigan, and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saddawi-Konefka
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000671:Amputation, Surgical; D006801:Humans; D023821:Limb Salvage; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D013978:Tibial Fractures / Q000473:pathology / Q000601:surgery*