title: Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III.
abstract: OBJECTIVE
  To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014.
  
  
  METHODS
  This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate.
  
  
  RESULTS
  116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group.
  
  
  CONCLUSIONS
  The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.
authors.affiliation: Department of Orthopedics and Traumatology, Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil; Universidade Nove de Julho, São Paulo, SP, Brazil.
authors.forename: Frederico Carlos
authors.initials: FC
authors.lastname: Jaña Neto
authors.affiliation: Universidade Nove de Julho, São Paulo, SP, Brazil.
authors.forename: Marina
authors.initials: M
authors.lastname: de Paula Canal
authors.affiliation: Department of Orthopedics and Traumatology, Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil.
authors.forename: Bernardo Aurélio Fonseca
authors.initials: BA
authors.lastname: Alves
authors.affiliation: Department of Orthopedics and Traumatology, Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil.
authors.forename: Pablício Martins
authors.initials: PM
authors.lastname: Ferreira
authors.affiliation: Department of Orthopedics and Traumatology, Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil.
authors.forename: Jefferson Castro
authors.initials: JC
authors.lastname: Ayres
authors.affiliation: Service of Traumatology and Orthopedics, Instituto Dr. José Frota, Fortaleza, CE, Brazil.
authors.forename: Robson
authors.initials: R
authors.lastname: Alves
keywords: Amputation/epidemiology; Amputation/methods; Tibial fractures