Abstract
Background: Traditionally, Gustilo Anderson grade 1Mb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures.
Materials and Methods: 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup.
Results: The mean score of Puno scoring system was 87.4 (range 67–94). The mean ROM of the knee and ankle joints was 121.3° (range 90°–130°) and 37.7° (range 15°–50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16–42 weeks). The mean coronal angulation was 2.1° (range 0–4°) and sagittal was 2.7° (range 1–4°). The mean shortening was 4.1 mm (range 0–8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection.
Conclusion: Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am 1990;72:299–304.
Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br 2001;83:62–8.
Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma 1984;24:742–6.
Yokoyama K, Itoman M, Shindo M, Kai H. Contributing factors influencing type III open tibial fractures. J Trauma 1995;38:788–93.
Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986;78:285–92.
Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: The radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br 2000;82:959–66.
Tielinen L, Lindahl JE, Tukiainen EJ. Acute unreamed intramedullary nailing and soft tissue reconstruction with muscle flaps for the treatment of severe open tibial shaft fractures. Injury 2007;38:906–12.
Ueno M, Yokoyama K, Nakamura K, Uchino M, Suzuki T, Itoman M. Early unreamed intramedullary nailing without a safety interval and simultaneous flap coverage following external fixation in type IIIB open tibial fractures: A report of four successful cases. Injury 2006;37:289–94.
Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 2007;21:355–61.
Ma CH, Wu CH, Yu SW, Yen CY, Tu YK. Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures. Injury 2010;41:190–6.
Muller ME, Allgöwer M, Schneider R, Willenegger H. The comprehensive classification of long bones. Manual of Internal Fixation. 3rd ed. Berlin: Springer-Verlag; 1991. p. 142–3.
Puno RM, Grossfeld SL, Henry SL, Seligson D, Harkess J, Tsai TM. Functional outcome of patients with salvageable limbs with grades III-B and III-C open fractures of the tibia. Microsurgery 1996;17:167–73.
Baker SP. Advances and adventures in trauma prevention. J Trauma 1997;42:369–73.
Milner SA. A more accurate method of measurement of angulation after fractures of the tibia. J Bone Joint Surg Br 1997;79:972–4.
Gopal S, Giannoudis PV, Murray A, Matthews SJ, Smith RM. The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage. J Bone Joint Surg Br 2004;86:861–7.
Yokoyama K, Itoman M, Nakamura K, Uchino M, Tsukamoto T, Suzuki T. Primary shortening with secondary limb lengthening for Gustilo IIIB open tibial fractures: A report of six cases. J Trauma 2006;61:172–80.
Sohn OJ, Kang DH. Staged protocol in treatment of open distal tibia fracture: Using lateral MIPO. Clin Orthop Surg 2011;3:69–76.
Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: A comparison of treatment methods. J Trauma 1999;47:937–41.
Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 1999;13:78–84.
Fabian TS, Kaufman HJ, Lett ED, Thomas JB, Rawl DK, Lewis PL, et al. The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing. Am Surg 2000;66:1136–43.
Morykwas MJ, Faler BJ, Pearce DJ, Argenta LC. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg 2001;47:547–51.
Stannard JP, Volgas DA, Stewart R, McGwin G Jr, Alonso JE. Negative pressure wound therapy after severe open fractures: A prospective randomized study. J Orthop Trauma 2009;23:552–7.
Conroy J, Agarwal M, Giannoudis PV, Matthews SJ. Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop 2003;27:343–7.
Franken JM, Hupkens P, Spauwen PH. The treatment of soft-tissue defects of the lower leg after a traumatic open tibial fracture. Eur J Plast Surg 2010;33:129–133.
Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect: A case report. Injury 2007;38:1318–25.
Granhed HP, Karladani AH. Bone debridement and limb lengthening in type III open tibial shaft fractures: No infection or nonunion in 9 patients. Acta Orthop Scand 2001;72:46–52.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
About this article
Cite this article
Park, C.H., Shon, O.J. & Kim, G.B. Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures. IJOO 50, 536–542 (2016). https://doi.org/10.4103/0019-5413.189604
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.189604