Le. Shepherd et al., LOCAL OR FREE MUSCLE FLAPS AND UNREAMED INTERLOCKED NAILS FOR OPEN TIBIAL FRACTURES, Clinical orthopaedics and related research, (350), 1998, pp. 90-96
The treatment of open tibial fractures associated with severe soft tis
sue injuries remains a difficult dilemma, even to the experienced frac
ture surgeon. To ascertain the efficacy of nailing tibial fractures wi
th severe soft tissue injuries, a review of all open tibial fractures
treated at the authors' institution was done. Those fractures initiall
y stabilized with non-reamed nails which required muscle flaps for cov
erage were selected for study. Thirty-three patients (26 men, seven wo
men) were treated with intramedullary nailing and muscle flap coverage
for the soft tissue defects. The average length of followup was 12.1
months (range, 7-42 months). The average time to union was 27 weeks (r
ange, 14-45 weeks). There were five (15%) infections: two (6%) superfi
cial wound infections, one (3%) flap infection, and two (6%) cases of
osteomyelitis. In no patient did the infection result in limb ablation
. Thirteen of 33 (42%) patients required secondary procedures to enhan
ce union. In this study, it was found that although delayed procedures
frequently were required to promote fracture union, the time to union
, and infection rates were not significantly different from those repo
rted for external fixation of fractures that require local or free mus
cle transfers.