Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2021; 12(7): 495-504
Published online Jul 18, 2021. doi: 10.5312/wjo.v12.i7.495
Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series
Kavi H Patel, Karl Logan, Matija Krkovic
Kavi H Patel, Karl Logan, Matija Krkovic, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, United Kingdom
Author contributions: Patel K performed the data collection, analysis and writing the paper; Logan K performed the data collection and analysis; Krkovic M edited the manuscript; all authors read and reviewed the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Cambridge University Hospital NHS Trust. No patients were involved or contacted in this study as data was derived from an electronic hospital database.
Informed consent statement: Informed consent is not required.
Conflict-of-interest statement: The authors declare that they have no conflict of interest and no funding was received for this study.
Data sharing statement: No consent for data sharing was given as all data was anonymized and there is no risk of identification.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kavi H Patel, MBBS, MSc, Doctor, Department of Trauma & Orthopaedics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom. drkavi84@gmail.com
Received: February 9, 2021
Peer-review started: February 9, 2021
First decision: May 3, 2021
Revised: May 16, 2021
Accepted: June 3, 2021
Article in press: June 3, 2021
Published online: July 18, 2021
Processing time: 155 Days and 23.2 Hours
Abstract
BACKGROUND

Severe open tibia fractures are challenging to treat with a lack of published clear management strategies. Our aim was to provide an overview of the largest single-center experience in the literature, with minimum 1-year follow-up, of adult type 3 open tibial shaft fractures at Cambridge University Hospitals (a United Kingdom major trauma center). We sought to define patient characteristics and our main outcome measures were infection, union and re-fracture.

AIM

To retrospectively define patient and injury characteristics, present our surgical methods and analyze our outcomes–namely infection, union and re-fracture rates.

METHODS

Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020 (26 classified as Gustilo-Anderson 3A, 47 were 3B and two were 3C). Nine patients underwent intramedullary nailing (IMN), 61 underwent Taylor spatial frame (TSF) fixation and 5 were treated with Masquelet technique (IMN and subsequent bone grafting).

RESULTS

Mean follow-up was 16 mo (IMN) and 25 mo (TSF). We had an infection rate of 6.7% (5), non-union rate of 4% (3) and re-fracture rate of 2.7% (2). Average time to union was 22 wk for IMN and 38.6 wk for TSF. Thirty-three cases had a bone defect with a mean of 5.4 cm (2-11). Patient age, sex, diabetes, smoking status or injury severity did not have a significant effect on union time with either fixation method. Our limb salvage rate was 98.7%.

CONCLUSION

Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN. Grade 3B/C injuries are best treated by circular external fixators as they provide good, reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.

Keywords: Tibia; Open fracture; Taylor spatial frame; Intramedullary nailing; Bone defect

Core Tip: Our aim was to provide an overview of the largest single-center experience in the literature, with minimum 1-year follow-up, of adult type 3 open tibial shaft fractures at Cambridge University Hospitals (a United Kingdom major trauma center). Meticulous and aggressive debridement of GA type 3 open tibia wounds by experienced orthopaedic and plastic surgeons is paramount. Grade 1 to 3A injuries can effectively be treated with reamed or unreamed intramedullary nailing. Grade 3B/C injuries are best treated by circular external fixators as they provide good if not superior outcomes to other limb salvage techniques and allow large bone defects to be addressed via distraction osteogenesis. In addition, Taylor spatial frame offers the advantages of postoperative adjustability.