Orthoplastic management of Gustilo–Anderson type IIIB/C open tibial fractures: a consecutive 10-year series from China Level I trauma center

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BACKGROUND: Research on open tibiofibular fractures is limited. We compared clinical outcomes of Gustilo - Anderson type IIIB/C open tibial fractures using orthopedic and orthoplastic approaches, and identified poor prognosis predictors. MATERIALS AND METHODS: The clinical data of 746 patients with Gustilo - Anderson type IIIB/C open tibial fractures (420 and 326 treated using the orthopedic and orthoplastic approach, respectively) were retrospectively analyzed. We evaluated infection rates, nonunion incidence, arthritis incidence, number of surgeries, fracture healing time, amputation rate, wound closure duration, and Lower Extremity Functional Scale (LEFS) score, and identified risk factors affecting prognosis. RESULTS: Significant differences in infection rates (deep infection, 8.0% vs. 29%; superficial infection, 8.0% vs. 41%; all P <0.001), nonunion incidence (11% vs. 2.5%, P <0.001), arthritis incidence (27% vs. 2.1%, P < 0.001), number of surgeries (4.6 ± 1.07 vs. 10.7 ± 3.33, P < 0.001), and wound coverage time (11.27 ± 5.14 vs. 3.98 ± 1.98, P < 0.001) were observed between the groups. LEFS scores from 3 to 24 months after injury were higher in the orthoplastic group. No difference in fracture healing time was observed (7.0 ± 1.99 vs. 7.0 ± 1.98, P = 0.987). The orthoplastic group required a lower amount of bone graft when using intramedullary nail fixation (6.8 ± 1.42 vs. 19.0 ± 2.88, P < 0.001). Smoking (odds ratio [OR], 0.24 for nonunion; 95% confidence interval [CI], 2.29-5.34; P = 0.008 and OR, 0.26 for deep infection; 95% CI, 0.10-0.71; P = 0.009), bone cement block formation (OR, 1.54; 95% CI, 2.06-4.73; P = 0.007), and local antibiotic use (OR, 4.89; 95% CI, 1.93-12.37; P < 0.001) were predictors of poor prognosis. CONCLUSION: The orthoplastic approach offers advantages in the treatment of Gustilo - Anderson type IIIB/C open tibial fractures. Smoking should be avoided, bone cement block molding should be actively adopted, and systemic and local antibiotics should be administered as early as possible. The Flap and Open Reduction Internal Fixation and Masquelet technique reduces the amount of bone graft without increasing deep infection risk.

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