Tibial Nail Combined with Vacuum Sealing Drainage for Gustilo Grade IIIB Open Tibial Fractures: A Patient Series

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Abstract

Gustilo grade IIIB open tibial fractures are relatively difficult to treat. We investigated the treatment effects of tibial intramedullary nails combined with vacuum sealing drainage (VSD) for Gustilo grade IIIB open tibial fractures. From March 2015 to March 2017, 13 cases of Gustilo grade IIIB open tibial fractures were treated with Expert Tibial Nails combined with VSD. Causes of injury included falls from a height (n = 9, 69.2%) and road accidents (n = 4, 30.8%). The duration from time of injury to hospital intake was 7.3 hours (range 5 to 9.5), and the time between injury and operation was 6.7 days (range 3 to 11). Six months after the operation, overall patient general health was investigated via the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the physical and mental health dimensions of the Short-Form Health Survey 36 (SF-36). Postoperative complications and infections also were recorded. The results indicated that the median AOFAS score was 93.7 (range 89 to 97), with all individuals having either excellent (90 to 100; n = 10, 76.9%) or good (80 to 89; n = 3, 23.1%) outcomes. The median physical SF-36 score was 83.1 (range 72.5 to 93.0), and the median mental SF-36 score was 80.6 (range 69.7 to 92.0). Moreover, there were no instances of tibial shortening, neurovascular injury, postoperative complications, implant failure, malunion, or serious infections. In conclusion, intramedullary tibial nail combined with VSD is a safe and effective method to treat type grade IIIB open tibial fractures.

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Methods

The study was approved by the Yantaishan Hospital (Yantai, China) ethics committee, and informed consent was provided by all patients. Between March 2015 and March 2017, this study involved a consecutive series of 13 Gustilo grade IIIB open tibial fractures (all patients were males between 43 and 68 years of age) treated with ETNs and VSD. Exclusion criteria included autoimmunity, pathologic fractures, severe multiple trauma, blood disorders, or surgical contraindications. The causes of injury

Results

Values of outcome variables are shown in Table 1. All of these data suggested satisfactory postoperational patient health. The median physical functioning SF-36 score was 83.1 (range 72.5 to 93.0), and the median SF-36 mental score was 80.6 (range 69.7 to 92.0). The median AOFAS score was 93.7 (range 89 to 97), with all individuals having either excellent (90 to 100; n = 10, 76.9%) or good (80 to 89; n = 3, 23.1%) outcomes. Moreover, there were no instances of tibial shortening, neurovascular

Discussion

There remains controversy with regard to the best means of treatment for Gustilo grade III B open tibial fractures complicated by bone loss. Some work suggests that intramedullary nails may be the best means of stabilizing fractures associated with large segmental defects (11). The success of such an approach is dependent on the availability of sufficient healthy vascularized tissue to cover the wound site, to minimize the risk of complications including serious infection or malunion (12).

ETNs,

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