Can defined surgical approach replace conventional extension approach for debridement of open tibial fractures?: A study

Abstract

Open tibial fractures are common and often result from high-energy trauma, leading to severe bone and soft tissue damage. Surgical debridement is crucial for managing such fractures, but the approach used for debridement can significantly impact outcomes. This study compares the safety and efficacy of a defined surgical approach (Marecek et al.) with the traditional direct extension approach for open tibial diaphyseal fractures. Materials and Methods: This prospective, longitudinal study was conducted at Medical College & Hospitals, Kolkata, from September 2022 to February 2024. Eighty adult patients with open tibial fractures were divided into two groups: Group A (defined surgical approach) and Group B (direct extension approach). Demographic, clinical, and radiological data were collected, and follow-up occurred at 4, 8, 12 weeks, and 6 months. Statistical analysis was performed using Chi-squared and Student's t-test. Results: In Group A, 8 patients required more than one surgery (mean 1.25), with 1 flap coverage and 3 infections. In Group B, 22 patients required more than one surgery (mean 1.78), with 10 flap coverages and 6 infections. The defined surgical approach resulted in fewer reoperations, flap requirements, and infections, though differences were not always statistically significant. Conclusion: The defined surgical approach for debridement of open tibial diaphyseal fractures is safe and effective, resulting in fewer reoperations and flap requirements compared to the traditional direct extension approach.