Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up.
OBJECTIVE
Salvage or amputation for grade 3C open fracture of tibia is not well responded question universally because of surgical innovations, cultural believes, difficulties in estimate the outcome, coasts, and different results in the literature. The aim of this study was to evaluate the surgical outcomes of Gustilo grade 3C open tibia fractures with at least two years follow-up in non-military adults.


METHODS
Twenty-two non-military patients with a mean age of 31.1 were operated with grade 3c open fractures at tibia level in last 10 years in our clinic. We evaluated them retrospectively and asked about their daily life, pain, and if present, about the wish for secondary amputation. We also asked if they would prefer a first day amputation rather than their present status.


RESULTS
Mean operation time after the injury was 13 h. Seven patients had nerve injury. Mean operation number was 3.5. Eight patients (%36) (all due to circulatory problem) had to have amputation. All patients treated with temporary unilateral external fixation than converted to circular external fixators when soft tissue healing was completed. Two patients were reoperated because of deformity. Four patients needed revision surgery because of non-union. At long term follow, we had osteomyelitis in one patient.


CONCLUSIONS
Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.
Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. dronurtunali@gmail.com.
O
O
Tunali
Department of Orthopedics and Traumatology, Biruni University, Istanbul, Turkey.
Y
Y
Saglam
Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
H I
HI
Balci
Department of Orthopedics and Traumatology, Sakarya University, Sakarya, Turkey.
A
A
Kochai
General Surgery Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
N A
NA
Sahbaz
Department of Cardiovascular Surgery, Istanbul Medical Faculty, Stanbul University, Istanbul, Turkey.
O A
OA
Sayin
Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
O
O
Yazicioglu
D000328:Adult; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014421:Turkey; D014656:Vascular Surgical Procedures / Q000379:methods*; D014945:Wound Healing; D055815:Young Adult
Amputation; Grade 3C open tibia fracture; Ischemia time; Salvage