The results of a prospective study of primary bone grafting in a selective group of patients with High energy open fractures (Grade III) of limbs with communition or bone loss are presented. Out of 310 Gustilo Grade III Open injuries managed over a 4 year period, 42 patients with Grade III injuries underwent bonegrafting after satisfying the inclusion criteria (Age <60, Debridement within 12hrs, Stable fracture fixation, wound cover within 72hrs) at or before the time of wound closure or soft tissue cover. Patients with Grade IIIc fractures, farmyard injuries, needing freeflaps, ASA grade of 3 or more, injury severity score > 25 or monomelic polytrauma were excluded. The bone involved was femur in 26 patients, tibia in 4, forearm in 9 and humerus in 3 patients. The injury was Grade IIIA in 11 and Grade IIIB in 31 patients. Wounds were primarily closed immediately after debridement in 28 (66.7%) patients, by split thickness skingrafting in 7 (16.7%) and by suitable regional flaps in 7 (16.7%) patients. Rigid fixation was achieved in all patients with variety of implants depending on the fracture personality. Autologous Cortico-cancellous bonegrafting was done immediately after debridement in 33 (78.6%) and within 72hrs at the time of soft tissue cover in 9 (21.4%) patients.Introduction
Materials and methods
