Late results of free-muscle flaps and delayed bone grafting in the secondary treatment of open distal tibial fractures.

Since no current studies reflect the long-term function of patients accurately categorized and uniformly managed for the same degree and location of tibial injury, seven individuals with type IIIB open distal tibial fractures were studied prospectively for 2 to 4 years after debridement, free-muscle transfer, and delayed autologous bone grafting. Lymphedema, transient drainage, poor ankle motion, limb shortening, nonunion, and delayed union were all significant problems. On average, the patients endured over six operations, 2 months of hospitalization, and a year's course of physical rehabilitation. The study indicates that, although popular, such a regimen is not without important shortcomings. This experience has influenced our selection of and counseling for patients in whom we are contemplating such management.