One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss

The purpose of this study was to report the authors' experience with emerge ncy reconstruction of severe tibial shaft fractures. Five male patients wer e admitted to the emergency room with a grade IIIB open tibial shaft fractu re with bone loss [average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibi otics, debridement, stabilization by locked intramedullary nailing, bone gr afting from the iliac crest, and coverage using free muscle flaps (four lat issimus dorsi and one gracilis). The average follow-up was 21 months (range , 8 months-3.5 years), Partial weight bearing with no immobilization was st arted at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis, All fractures healed within 6 mont hs in 4 patients and within 10 months in 1 patient. At the last follow-up e xamination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Agg ressive emergency management of severe open tibial fractures provides good results, It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.