title: Lower extremity soft tissue reconstruction and amputation rates in patients with open tibial fractures in Sweden during 1998-2010.
abstract: BACKGROUND
  The rates of soft tissue reconstruction and amputation after open tibial fractures have not been studied on a national perspective. We aimed to determine the frequency of soft tissue coverage after open tibial fracture as well as primary and secondary amputation rates.
  
  
  METHODS
  Data on all patients (> = 15 years) admitted to hospital with open tibial fractures were extracted from the Swedish National Patient Register (1998-2010). All surgical procedures, re-admissions, and mechanisms of injury were analysed accordingly. The risk of amputation was calculated using logistic regression (adjusted for age, sex, mechanism of injury, reconstructive surgery and fixation method). The mean follow-up time was 6 (SD 3.8) years.
  
  
  RESULTS
  Of 3,777 patients, 342 patients underwent soft tissue reconstructive surgery. In total, there were 125 amputations. Among patients with no reconstructive surgery, 2% (n = 68 patients) underwent amputation. In an adjusted analysis, patients older than 70 years (OR = 2.7, 95%, CI = 1.1-6) and those who underwent reconstructive surgery (OR = 3.1, 95% CI = 1.6-5.8) showed higher risk for amputation. Fixations other than intramedullary nailing (plate, external fixation, closed reduction and combination) as the only method were associated with a significant higher risk for amputation (OR 5.1-14.4). Reconstruction within 72 hours (3 days) showed better results than reconstruction between 4-90 days (p = 0.04).
  
  
  CONCLUSIONS
  The rate of amputations after open tibial fractures is low (3.6%). There is a higher risk for amputations with age above 70 (in contrast: male sex and tissue reconstruction are rather indicators for more severe soft tissue injuries). Only a small proportion of open tibial fractures need soft tissue reconstructive surgery. Reconstruction with free or pedicled flap should be performed within 72 hours whenever possible.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Tampe
authors.forename: Rüdiger J
authors.initials: RJ
authors.lastname: Weiss
authors.forename: Birgit
authors.initials: B
authors.lastname: Stark
authors.forename: Pehr
authors.initials: P
authors.lastname: Sommar
authors.forename: Zewar
authors.initials: Z
authors.lastname: Al Dabbagh
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet at Karolinska University Hospital, SE-17176 Stockholm, Sweden. karl-ake.jansson@karolinska.se.
authors.forename: Karl-Åke
authors.initials: KÅ
authors.lastname: Jansson
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D013548:Sweden / Q000453:epidemiology; D013978:Tibial Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*