Background: The open tibial diaphyseal fracture remains a treatment
challenge. The purpose of the present analysis of the long-term follow-up data
on a previously reported cohort of patients was to identify surgeon-controlled
variables that affected fracture union, complications, and final outcome in
patients who had sustained a severe open tibial shaft fracture.
Methods: A cohort of 156 patients with a limb-threatening open
tibial diaphyseal fracture was identified from the Lower Extremity Assessment
Project (LEAP) study group. The patients were prospectively followed for two
to seven years. In addition to the Sickness Impact Profile, other outcome
metrics included the time to fracture union as well as the occurrence of
infection and other complications that required rehospitalization. Statistical
differences between groups were calculated.
Results: Within the parameters of the present study, the timing of
débridement, the timing of soft-tissue coverage, and the timing of
bone-graft placement had no effect on outcome. Patients in whom the fracture
was definitively treated with an external fixator had more surgical
procedures, took longer to achieve full weight-bearing status, and had more
readmissions to the hospital for the treatment of infection and nonunion than
did those in whom the fracture was treated with an intramedullary nail.
Patients undergoing external fixation who also had a muscle flap for wound
coverage had more physical impairment and a worse functional outcome than did
patients who had an amputation.
Conclusions: Surgeons should carefully consider alternative
treatment options for patients who have a severe open tibial fracture when
limb salvage is perceived to require the combination of external fixation for
fracture fixation and a muscle flap for wound coverage.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.