Evaluation of functional and radiological outcome of type iii open distal tibial fractures treated with early internal fixation followed by soft tissue reconstruction [fix and flap]: A prospective study

Abstract

The treatment of Gustilo Anderson type 3 open distal tibia intrartricular fractures is a major challenge to orthopaedic surgeons which needs aggressive debridement, adequate fixation, and early flap coverage of soft tissue defect through Osteoplastic approach rather than conventional orthopaedic approach alone. The incidence of these fracture are on surge due to urbanistaion and high velocity motor vehicle accidents. This study has been done to evaluate functional and radiological outcome in gustillo type 3b open fractures by early definitve fixation and soft tissue cover. Twenty six patients were operated by fix and flap protocol and evaluated at the end of one year with IOWA ankle scoring system and its radiological outcome and their complications. Among 26 patients treated with this protocol the union rate is 100% and the mean union time is 29weeks with 3 patients developed malunion and one patients presented with ankle arthritis. Two patients (7%) developed deep infection in which one patient also having delayed union and two patients (7%) developed superficial infection. Functional results were graded according to the IOWA ankle scoring system. 11 patients had excellent to good outcomes and 11 were fair outcome and remaining 4 patients shows poor outcome. Fix and Flap in the same sitting using immediate wound cover at the time of definitive fixation, has given good results in our hands despite the communition at fracture site and open wound.