Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study
Introduction: The tibia, the second largest bone in the human body, is largely enveloped by subcutaneous fat and skin, rendering it vulnerable to fractures and soft tissue injuries. This unique anatomical configuration contributes to a heightened susceptibility to open fractures. Notably, an agg...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18818/66143_CE[Ra1]_F(SL)_QC_PAT.(SHK_RN_SHU)_PF1(AG_OM)_PFA(NC_OM)_PN(KM).pdf |
| Summary: | Introduction: The tibia, the second largest bone in the human
body, is largely enveloped by subcutaneous fat and skin,
rendering it vulnerable to fractures and soft tissue injuries. This
unique anatomical configuration contributes to a heightened
susceptibility to open fractures. Notably, an aggressive treatment
protocol involving radical debridement, internal fixation, and
immediate or early soft tissue coverage with muscle flaps
has demonstrated improved rates of bony union and reduced
incidences of infection.
Aim: To assess the clinical outcomes of early bony fixation and
soft tissue coverage in Type IIIB open proximal tibia fractures.
Materials and Methods: This cross-sectional observational
study was conducted at the Department of Orthopaedics, BRD
Medical College, in Gorakhpur, Uttar Pradesh, India. Total of
30 cases were enrolled between August 2021 and November
2022. The parameters assessed in the study encompassed
patient demographics, including age and gender distribution,
the aetiology of fractures, soft tissue coverage outcomes,
time to bone union, knee joint movement postsurgery, and
the incidence of complications such as superficial infections
and chronic osteomyelitis. The analysis was conducted using
Statistical Package for Social Sciences (SPSS) version 26.0,
primarily employing descriptive statistics to present the results,
with percentages and frequencies serving as the primary modes
of representation.
Results: All cases of Gustilo-Anderson Type IIIB high-grade
open tibial fractures were included in this study, with the majority
of patients being males 26 (87%) aged between 20 to 40 years.
Road traffic accidents accounted for 25 (83.3%), while falls
from height were responsible in 5 (16.7%) cases. Assessment
of soft tissue coverage revealed 73.33% with good healing,
20% with fair healing, and 6.67% with poor healing. The time
to bone union varied, with 10% of cases showing non union.
Postsurgery, most cases demonstrated knee joint movement of
over 120° (86.67%) and a few cases with movement ranging
between 90-120° (13.33%). The incidence of complications
was relatively low, with 3 (10%) cases presenting superficial
infections and 2 (6.7%) suffering from chronic osteomyelitis.
Conclusion: Early bony fixation and soft tissue coverage utilising
the medial gastrocnemius flap, along with Split-Thickness Skin
Grafting (STSG), demonstrate efficacy in treating high-grade
open proximal tibia fractures (Gustilo-Anderson Type IIIB). This
approach facilitates expedited bony union and contributes to a
reduction in postoperative complications. |
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| ISSN: | 2249-782X 0973-709X |