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Clinical analysis of accelerated rehabilitation surgery for Gustilo type IIIA/B open tibio fibular fracture

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Abstract

Purpose

To investigate the clinical efficacy of accelerated rehabilitation surgery for the treatment of Gustilo type IIIA/B open tibiofibular fracture with emergency stage I debridement, internal fracture fixation, bone grafting, coverage of the wound surface with a muscle flap combined with vacuum sealing drainage (VSD), and internal and lateral leg reduction.

Methods

A retrospective analysis was performed on the clinical data of 15 patients with Gustilo type IIIA/B open tibiofibular fracture who were admitted to the Affiliated Zhongshan Hospital of Dalian University from January 2015 to December 2018. There were 12 males and 3 females. The patients ranged in age from 20 to 62 years, with an average of 39.5 years. After admission, the patients underwent stage I emergency debridement (including exploration and repair of nerves and tendons), open reduction and internal fixation of the tibia and fibula, iliac bone grafting, muscle flap and VSD coverage of the bone defect, complete tensioning of the calf inside and outside, tibia-sparing incision before healing, and stage II free skin grafting. Patients were followed up periodically to observe muscle flap survival, fracture healing time, length of hospitalization, wound healing time, delayed union, bone nonunion, osteomyelitis and other complications. At the last follow-up, the Johner–Wruhs criteria were used to evaluate the rate of good functional recovery from tibial shaft fracture, fracture healing quality was evaluated by the Merchant score, and limb function was evaluated by the LEFS.

Results

All 15 cases were followed up for 12–32 months, with an average of 22.8 months. All the fractures healed; the range of healing time was 14–30 weeks (mean 18.5 weeks). The length of hospitalization was 25.1 ± 7.6 days, and wound healing took 12.2 ± 2.0 days. None of the patients had complications such as osteomyelitis infection. When the Johner–Wruhs evaluation criteria for functional recovery from tibial shaft fracture were applied at the last follow-up, the outcomes were as follows: excellent in 13 cases, good in 1 case and fair in 1 case, for an excellent and good rate of 93.3%. When fracture healing was evaluated according to the Merchant scoring standard, the outcomes were as follows: excellent in 12 cases, good in 1 case, fair in 1 case, and poor in 1 case, for an excellent and good rate of 86.7%. The mean LEFS score of the affected limb at the last follow-up was 70 (59–80).

Conclusion

For Gustilo type IIIA/B open tibiofibular fractures, emergency stage I debridement, internal fixation of the fracture, bone grafting, coverage of the wound with a muscle flap, complete tensioning of the calf inside and outside, and application of VSD can improve the repair of leg soft-tissue defects, shorten hospitalization time, promote fracture healing, and effectively reduce infection and complications related to bone exposure. More importantly, this treatment protocol provides effective wound repair, guarantees the recovery of limb function, significantly speeds up recovery, and improve patients’ quality of life.

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Data availability

The datasets generated or analyzed during this study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China

    Xiaowei Ma, Zongpu Wang & Jianchuan Wang

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  1. Xiaowei Ma
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Correspondence to Jianchuan Wang.

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All authors unanimously declare that there is no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ma, X., Wang, Z. & Wang, J. Clinical analysis of accelerated rehabilitation surgery for Gustilo type IIIA/B open tibio fibular fracture. Eur J Trauma Emerg Surg 49, 2355–2362 (2023). https://doi.org/10.1007/s00068-022-02164-x

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