Revista de la Asociación Argentina de Ortopedia y Traumatología
versión On-line ISSN 1852-7434
MARANGONI, Lucas D. et al. High Energy Diaphyseal Tibial Fractures Associated With Soft Tissue Injury. Staged Management Protocol. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2009, vol.74, n.1, pp. 33-39. ISSN 1852-7434.
Background: The treatment of high energy diaphyseal tibial fractures with soft tissue injury continues to be complex and controversial. We propose to treat these injuries by means of a staged management protocol. The aim of this paper was evaluate a staged management protocol, complications and functional results in this type of fractures. Material and Methods: Between July 2002 and May 2006 we evaluated 20 patients with 20 tibial fractures. We used the AO (6 A1, 4 A2, 2 A3, 2 B1, 3 B3, 1 C1 and 2 C2), Tscherne and Oestern (6 GIII) and Gustilo and Anderson (3 IIIA, 9 IIIB, 2 IIIC) classifications. Treatment protocol: irrigation and broad debridement of the wound in open fractures, stabilization with an AO external tubular fixator and in a second step conversion to an intramedullary nail with or without reaming. Results: average follow-up 33 months, average time of fixator's conversion to a nail: 14 days. In 4 cases we used latissimus dorsi free flaps, in 5 gastrocnemius rotational flaps, and in 9 cases skin flaps. The definitive treatment involved reamed locked intramedullary nail in 16 patients, and unreamed intramedullary nail in 4 patients. Average fracture-healing time was 6 months. 15 knees presented excellent results, 4 good and 1 fair. 16 ankles presented excellent results, and 4 good. Complications: 1 latissimus dorsi necrosis, two superficial and one deep infections, and two non-unions. Conclusions: We consider that the use of external temporary fixation and subsequent conversion to an intramedullary nail represents a satisfactory alternative, with minor associated morbidity for the treatment of high energy diaphyseal tibial fractures associated with soft tissue injury.
Palabras clave : Tibial fractures; High energy; Staged management protocol; Soft tissue injury.