Analysis of Functional Outcome of Staged Treatment of Gustilo Anderson 3B Tibia Fractures: Experience from Tertiary Care Hospital of North India

  • Sagar Arora Junior Resident, Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
  • Kapil Bansal Associate Professor, Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
  • Deepak John Bhatti Professor, Department of Plastic Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
  • Radhe Shyam Garg Professor, Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
  • Durgesh Singh Junior Resident, Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
  • Nikhil Gupta Junior Resident, Department of Orthopaedics, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.
Keywords: Outcome, Tibia Fractures, Orthopaedic.

Abstract

Introduction: Open fractures of the tibia are the most common open long bone fractures, with an annual incidence of 3.4 per 100 000. The management of open tibia fractures with loss of skin and soft tissue coverage is complex and requires combined orthopaedic and plastic surgery expertise. Our objective was to analyse the functional outcome of staged treatment of Gustilo 3B tibia fractures.

Methodology: 30 cases of Gustilo Anderson 3b tibia fractures aged 18-70 years were recruited as study participants. Treatment was given in three stages. First stage included debridement and irrigation using normal saline followed by stabilization of fracture with external fixator application. Second stage involved skin flap or soft tissue repositioning with skin graft. Third stage was external fixator removal with internal fixation of bone with or without bone graft.

Results: All the patients were managed for injury and fracture with staged treatment protocol. All the skin flaps/grafts survived. During the internal fixation, 4 (13.3%) patients underwent bone grafting. Bone union occurred at predicted time in 28 cases. Treatment outcome was excellent in 63.3%, good in 23.3% and fair in 13.3% patients.

Conclusion: Management of such fractures is appropriately done using staged treatment approach. The treatment planning and execution should incorporate principles of infection control.

Downloads

Download data is not yet available.

References

1. Bourne M, Sinkler MA, Murphy PB. Anatomy, Bony Pelvis and Lower Limb, Tibia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526053/
2. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am] 1976;58-A:453-8.
3. 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.
4. Beebe MJ, Auston DA, Quade JH, Serrano-Riera R, Shah AR, Watson DT, et al. OTA/AO classification is highly predictive of acute compartment syndrome after tibia fracture: A cohort of 2885 fractures. J Orthop Trauma. 2017;31(11):600–5.
5. Odatuwa-Omagbemi DO. Open fractures: Epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria. Pan Afr Med J. 2019;33(1):33.
6. Tropet Y, Garbuio P, Obert L, Ridoux PE. Emergency management of type IIIB open tibial fractures. Br J Plast Surg. 1999;52(6):462–70.
7. Clark D, Nakamura M, Miclau T, Marcucio R. Effects of Aging on Fracture Healing. Vol. 15, Current Osteoporosis Reports. Current Medicine Group LLC 1; 2017. p. 601–8.
8. Cross W, Swiontkowski M. Treatment principles in the management of open fractures. Vol. 42, Indian Journal of Orthopaedics. Indian Orthopaedic Association; 2008. p. 377–86.
Published
2021-07-12
How to Cite
1.
Arora S, Bansal K, Bhatti DJ, Garg RS, Singh D, Gupta N. Analysis of Functional Outcome of Staged Treatment of Gustilo Anderson 3B Tibia Fractures: Experience from Tertiary Care Hospital of North India. Int Arch BioMed Clin Res [Internet]. 2021Jul.12 [cited 2021Jul.25];7(2):OT1-OT5. Available from: https://iabcr.org/index.php/iabcr/article/view/728
Section
ORIGINAL ARTICLES ~ Orthopaedics