Abstract
Introduction
Grade IIIa/b open tibial fractures (OTF) result mostly following high energy trauma and may be accompanied by significant associated injuries. Aim of this study was to compare the characteristics and the outcome of OTF between patients of different injury severities.
Materials and methods
Retrospective analysis of the records of patients admitted to a level I centre in a 4 year period with an OTF. Epidemiologic data, AO-ASIF classification, method of treatment, complication rates and time to fracture-union have been statistically analysed. An AIS98-ISS threshold (ISS 16) was used to separate OTF in 2 groups (A<16, B>16).
Results
Forty-one cases of OTF have been retrieved. Group A included 28 and Group B 13 patients. Gender ratio and mechanisms of injuries did not show significant differences. Median age was 35.5 vs 41 years and median ISS 9.7 vs 26 for A and B groups respectively. AO types 42.A and 42.B were identified in 25% vs 23%, and type 42.C in 50% and 53% respectively. External fixation was used in 33% of the less severely injured and in 61% of the severely injured OTF; nailing techniques in 54% and 31% and covering flaps in 57% and 77% in that order. Secondary interventions were recorded in 38% of the B group but only in 17% of the A group. Median time to union was prolonged for over 1 month in the more severely injured group (28 vs 24 months). Complication rates had significant higher representation to the polytrauma group (39% and 17%).
Conclusion
Treatment and prognosis of severe open fractures was proven to be influenced by the overall injury severity in our patients' group. The achieved healing rates for both groups were acceptable, but fracture union required more time with increasing injury severity score.
