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...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| 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 |
| _version_ | 1797387366617317376 |
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| author | Pankaj Kumar Verma Surendra Kumar Avinash Singh Mohammad Vaseem HS Shrishma |
| author_facet | Pankaj Kumar Verma Surendra Kumar Avinash Singh Mohammad Vaseem HS Shrishma |
| author_sort | Pankaj Kumar Verma |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T22:24:04Z |
| format | Article |
| id | doaj.art-ff78dc1682954ba8a84e12885d68734e |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-08T22:24:04Z |
| publishDate | 2023-12-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-ff78dc1682954ba8a84e12885d68734e2023-12-18T11:44:03ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-12-011712010410.7860/JCDR/2023/66143.18818Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional StudyPankaj Kumar Verma0Surendra Kumar1Avinash Singh2Mohammad Vaseem3HS Shrishma4Postgraduate Resident, Department of Orthopaedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India.Associate Professor, Department of Orthopaedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India.Senior Resident, Department of Orthopaedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India.Postgraduate Resident, Department of Orthopaedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India.Senior Resident, Department of Anaesthesia, BRD Medical College, Gorakhpur, Uttar Pradesh, India.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.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).pdfflapsfracturesinjuriesskin grafts |
| spellingShingle | Pankaj Kumar Verma Surendra Kumar Avinash Singh Mohammad Vaseem HS Shrishma Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study Journal of Clinical and Diagnostic Research flaps fractures injuries skin grafts |
| title | Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study |
| title_full | Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study |
| title_fullStr | Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study |
| title_full_unstemmed | Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study |
| title_short | Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study |
| title_sort | early bony fixation and soft tissue coverage in type iiib open proximal tibia fractures a cross sectional study |
| topic | flaps fractures injuries skin grafts |
| url | 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 |
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