TREATMENT OF IIIB OPEN TIBIAL FRACTURES WITH EARLY OSTEOSYNTHESIS ANDLOCAL MUSCLE FLAPS

From 1986 to 1994 18 patients with 19 IIIB open tibial fractures were treated following similar therapeutic management. This included early and radical primary debridement, early and whereever possible immediat e internal fixation of the bone and coverage with a local muscle flap (hemisoleus or gastrocnemius). At the time of follow-up all fractures had consolidated clinically as well as radiographically. The mean time to bony union was 7 months (3-20). Twelve patients did not have any s evere pain and were able to walk for more than 4 km. The time to retur n to work averaged 8 months. In 2 cases a permanent disability of 50% was established. Fourteen of 18 patients were satisfied with the funct ion of the leg. On the other hand, 9 didn't like the aesthetic appeara nce and were inhibited because of it. The following complications occu rred within a period of 2 years: non-union (3), flap necrosis (2), ost eomyelitis (2), delayed union (4). The mean number of reoperations was 3 (0-8). In no case did an amputation have to be performed.