LOCAL OR FREE MUSCLE FLAPS AND UNREAMED INTERLOCKED NAILS FOR OPEN TIBIAL FRACTURES

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.