[Results of treatment of 475 second- and third-degree open fractures of long tubular bones (1974-1988)].

Open fractures with severe soft tissue damage are undergoing a change in therapeutic management. The impairment of vascularisation concerning bone and surrounding tissue has been gaining increasing importance. In addition to the primary stabilisation of 2 degrees and 3 degrees open fractures of long bones by external fixation including open wound treatment with artificial skin substitutes, local or free muscle flaps became an essential part of therapy. The early change of method after reconstruction of the soft tissue defect from external fixation to an internal osteosynthesis, i.e. the interlocking nail, as well as the use of autogenous cancellous bone graft and the possibility of segmental transport techniques are additional procedures. From 1974 to 1988 a total of 475 2 degrees and 3 degrees open fractures of long bones were initially treated at the BGU Tübingen. The follow-up of three groups of patients shows the development in therapeutic management of these severe injuries. In spite of a considerable rate of postoperative infections most cases show satisfactory functional results within an acceptable period of time (infection rate between 11.4 and 22.2%, average bone healing between 26 and 30 weeks).