title: Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail & covered with fasciocutaneous flap.
abstract: OBJECTIVE
  To evaluate the role of immediate and definitive management of Gustilo type III A/B tibia fractures with intramedullary nailing and fasciocutaneous flap.
  
  
  METHODS
  From August 2010 to July 2012, 22 patients with Gustilo Grade III A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap & reamed intramedullary nailing and were included in the study. The severity of the injury was calculated with Ganga Hospital injury severity score.
  
  
  RESULTS
  The mean age of patients was 41 years and the follow-up time ranged from six months to one year. Among the 22 patients, 73% were type III B fractures with upper leg involved in 55% of them. The time interval from injury to completion of surgery was 8-14 h. The incidence of bone infection requiring secondary procedure was 9%; the major and minor soft tissue complication rate was 9% and 14% respectively. The limb salvage rate was 100%.
  
  
  CONCLUSIONS
  Multidisciplinary management of severe lower limb trauma is important and provides good outcomes. Intramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade III A & B tibia fractures.
authors.affiliation: Plastic & Reconstructive Microvascular Services, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: G I
authors.initials: GI
authors.lastname: Nambi
authors.affiliation: Department of Orthopaedics, Pramukswami Medical College, Srikrishna Hospital, Karamsad 388325, Anand, Gujrat, India. Electronic address: drabhijeetsalunke@gmail.com.
authors.forename: Abhijeet Ashok
authors.initials: AA
authors.lastname: Salunke
authors.affiliation: Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: S G
authors.initials: SG
authors.lastname: Thirumalaisamy
authors.affiliation: Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: V Lenin
authors.initials: VL
authors.lastname: Babu
authors.affiliation: Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: K
authors.initials: K
authors.lastname: Baskaran
authors.affiliation: Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: T
authors.initials: T
authors.lastname: Janarthanan
authors.affiliation: Department of Orthopaedics & Traumatology, Kovai Medical Center & Hospital, Coimbatore 641014, India.
authors.forename: K
authors.initials: K
authors.lastname: Boopathi
authors.affiliation: Department of Orthopedics, National University Hospital, Singapore.
authors.forename: Yong Sheng
authors.initials: YS
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000601:surgery*
keywords: Fasciocutaneous flap; Fracture fixation, intramedullary; Gustilo type III A/B; Tibial fractures, open