Abstract
The purpose of our study was to evaluate several specific methods of skeletal stabilisation and soft-tissue treatment of open fractures in the orthopaedic department in a district hospital.
After stabilisation of the patient and diagnosis of concomitant injuries, the basic initial evaluation of the fracture type, soft-tissue laceration, and neurovascular status is made. Deformities of the legs are realigned promptly. Sterile wound dressing and early intravenous administration of antibiotics are applied. Prophylaxis against tetanus is considered.
Radiograph diagnostics are made and the Tscherne, Gustilo and Anderson classifications of open fractures are used. All devitalised tissue is removed in the operating theatre. The following methods of bone stabilisation are used: immobilisation in a cast, external fixation, and intramedullary nailing. Repeated debridement of soft-tissue is carried out. Postoperatively, time duration for bone-healing and deep infections were analysed.
During the past five years, 159 patients with a tibial shaft fracture were treated. Twenty-six were open fractures Type I (8), Type II (9), Type IIIA (7), and Type IIIB (2). Methods of stabilisation were cast (5), external fixation (7) and intramedullary rod (14).
Deep infection in Type III fractures was reported in two cases and a non-union in one case. Bone grafting was performed in two cases. Nailing followed short-term use of an external fixator in three cases. No amputations were necessary. The average time (in months) for union was 5 (Type I), 5.8 (Type II), and 8 (Type III).
Our experience agrees with the principle that the method of choice is intramedullary nailing that may follow the short-term use of an external fixation. Open fractures of the tibial shaft represent a limb-threatening and potentially life-threatening emergency. Optimum treatment involves appropriate initial evaluation, the administration of antibiotics, urgent operative debridements, skeletal stabilisation, and early soft-tissue closure or flap-coverage.
The type of treatment depends on the individual characteristics of the fracture and the concomitant soft-tissue injury. Fractures with a higher degree of comminution and soft-tissue laceration have more complications.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
