Bone debridement and limb lengthening in type III open tibial shaft fractures - No infection or nonunion in 9 patients

We retrospectively reviewed a consecutive series of 9 patients with tibial shaft fractures and extensive soft tissue damage, who had completed treatme nt by means of bone resection and distraction. 4 patients had type IIIB fra ctures and 5 type IIIC, The median followup time after bone resection was 2 7 (12-43) months. All patients were treated with debridement of devitalized soft tissue and resection of dead bone at the fracture site. The median bo ne shortening was 4 (3-9) cm. Equal limb-length was restored by proximal co rticotomy and lengthening. A free vascular flap in 5 patients and a local f lap in 4 patients corrected the soft tissue loss. All soft tissue transfers were successful, except in 1 case, which healed after a new free flap was made. The median union time of the fracture was 8 (4.5-28) months from the injury and 7 (3-10) months from the time of bone resection. There were no d eep infections or nonunions and no secondary amputations. This series shows that bone debridement and limb lengthening, with a multid isciplinary approach, is often successful in salvaging limbs at high risk o f amputation.