Tongzhu Bao1, Fang Han2, Feng Xu2, Yi Yang1, Xun Shu1, Ken Chen1, Baiwen Qi3, Shijun Wei4, Aixi Yu5. 1. Department of Orthopedics, Yichang Central People's Hospital and The First Affiliated Hospital of China Three Gorges University, Yichang, 443002, China. 2. Department of Orthopedics, Wuhan General Hospital, No. 627 Wuluo Road, Hongshan Area, Wuhan, 430070, China. 3. Department of Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. 4. Department of Orthopedics, Wuhan General Hospital, No. 627 Wuluo Road, Hongshan Area, Wuhan, 430070, China. wsj1974@yeah.net. 5. Department of Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. yuaixi666@163.com.
Abstract
PURPOSE: Treatment of open tibial fractures with soft tissue and segmental bone defects is difficult. This study reports our results for treating these injuries with a combination of Papineau open bone grafting and vacuum-assisted wound closure (VAC). METHODS: The records of 19 patients with open tibial fractures with soft tissue and segmental bone defects treated with bone grafting and VAC from 2004 to 2010 were retrospectively reviewed. Outcomes included: time to complete granulation tissue coverage, wound healing, and bone union; length of hospitalization; frequency of debridement; number of deep tissue infections. RESULTS: Initial surgery was performed within 48 hours of injury. Ten fractures were Orthopaedic Trauma Association classification 41-A3, one was 41-C3, seven were 43-A3, and one was 43-C3. No surgical complications occurred, and the mean length of hospitalization was 11.0 ± 3.0 weeks (range, 7-18 weeks). The mean follow-up time was 59.35 ± 8.76 months. The mean time for complete wound healing was 7.76 ± 1.52 weeks (range, 6-11 weeks). Bone union was achieved in all patients at a mean of 33.88 ± 8.37 weeks (range, 23-53 weeks). Only one patient developed a deep tissue infection, which was treated with antibiotics and debridements, and complete bone union wound healing was achieved. Based on Paley grade, five outcomes were excellent, eight were good, and four were fair. CONCLUSIONS: The combination of VAC and open bone grafting results in good outcome for patients with open tibial fractures and severe bone and soft-tissue defects.
PURPOSE: Treatment of open tibial fractures with soft tissue and segmental bone defects is difficult. This study reports our results for treating these injuries with a combination of Papineau open bone grafting and vacuum-assisted wound closure (VAC). METHODS: The records of 19 patients with open tibial fractures with soft tissue and segmental bone defects treated with bone grafting and VAC from 2004 to 2010 were retrospectively reviewed. Outcomes included: time to complete granulation tissue coverage, wound healing, and bone union; length of hospitalization; frequency of debridement; number of deep tissue infections. RESULTS: Initial surgery was performed within 48 hours of injury. Ten fractures were Orthopaedic Trauma Association classification 41-A3, one was 41-C3, seven were 43-A3, and one was 43-C3. No surgical complications occurred, and the mean length of hospitalization was 11.0 ± 3.0 weeks (range, 7-18 weeks). The mean follow-up time was 59.35 ± 8.76 months. The mean time for complete wound healing was 7.76 ± 1.52 weeks (range, 6-11 weeks). Bone union was achieved in all patients at a mean of 33.88 ± 8.37 weeks (range, 23-53 weeks). Only one patient developed a deep tissue infection, which was treated with antibiotics and debridements, and complete bone union wound healing was achieved. Based on Paley grade, five outcomes were excellent, eight were good, and four were fair. CONCLUSIONS: The combination of VAC and open bone grafting results in good outcome for patients with open tibial fractures and severe bone and soft-tissue defects.
Entities:
Keywords:
Bone graft; Open fracture; Papineau technique; Segmental bone defect; Tibia fracture; Vacuum-assisted closure
Authors: Cyril Mauffrey; David J Hak; Peter Giannoudis; Volker Alt; Christoph Nau; Ingo Marzi; Peter Augat; J K Oh; Johannes Frank; Andreas Mavrogenis; Xavier Flecher; Jean-Noel Argenson; Ashok Gavaskar; David Rojas; Yehia H Bedeir Journal: Int Orthop Date: 2018-05-03 Impact factor: 3.075