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Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_7 | Pages 22 - 22
1 May 2015
Mathews J Ward J Chapman T Khan U Kelly M
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Grade III Open fractures of the tibia represent a serious injury. It is recognised that combined management of these cases by experienced orthopaedic and plastic surgeons improves outcomes. Previous studies have not considered the timing of definitive soft tissue cover in relation to the definitive orthopaedic management. We reviewed medical notes of 73 patients with 74 Grade III Open tibia fractures (minimum 1 year follow up), to compare deep infection rates in patients who had a) a single-stage definitive fixation and soft tissue coverage vs. those who had separate operations, and b) those who had definitive treatment completed in < 72 hours vs. > 72 hours.

Of subjects that underwent definitive fixation and coverage in a single procedure, 4.2% developed deep infections, compared with 34.6 % deep infection(p<0.001) in those who underwent definitive treatment at separate operations. Of patients who had definitive treatment completed in < 72-hours, 20.0% developed deep infections a compared with 12.2%(p=0.4919) in the >72-hour group.

Patients with Gustilo III open tibial fractures have lower rates of deep infection if definitive fixation and coverage are performed in a single-stage procedure. Emphasis should be placed on timely transfer to a specialist centre, aiming for a single-stage combined orthoplastic surgery.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 45 - 45
1 Feb 2012
Topping A Warr R Graham A Pearse M Khan U
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The literature states pre-operative angiography of open tibial fractures (OTFs) should only be considered if abnormal pedal pulses are present.

Aim

Does pre-operative angiography of OTFs benefit patient management?

Method

43 patients were admitted with OTFs to Charing Cross Hospital, London between 3/2004 and 6/2005. Pedal pulses were documented and routine pre-operative angiography performed following primary surgical debridement. At definitive operation, data was collected prospectively assessing vasculature and the microsurgical findings. All patients underwent free flap reconstruction or amputation. Comparison was made with angiographic findings and whether surgical management had been affected. Retrospective audit of all angiograms was performed by a consultant radiologist establishing the sensitivity/specificity.