A Retrospective Comparative Cohort Study Comparing Temporary Internal Fixation to External Fixation at the First Stage Debridement in the Treatment of Type IIIB Open Diaphyseal Tibial Fractures

Abstract

Objectives: To compare the rates of deep infection, flap failure and nonunion after temporary internal fixation (TIF), with temporary external fixation (ex-fix) in the management of Gustilo-Anderson (GA) type IIIB open tibia fractures. Design: Retrospective comparative cohort. Setting: Level 1 trauma center. Patients/Participants: 64 consecutive patients with a GA type IIIB open diaphyseal tibia fracture (OTA/AO 42) were treated between May 2014 and May 2016. 47 patients (TIF = 24; ex-fix = 23) met the inclusion criteria and underwent two-stage reconstruction. Definitive fixation was with an intramedullary nail.Intervention: Temporary fracture stabilization at the first stage debridement was achieved with either TIF with a plate, or ex-fix. Main Outcome Measurement: Deep infectionResults: There were 4 complications in the ex-fix group (3 infection and 1 nonunion) and 2 complications in the TIF group (1 infection and 1 flap failure). Multiple regression modelling revealed infection (p=0.610), nonunion (p=0.918) and flap failure (p=0.112) were not significantly associated with the mode of temporary fixation or other demographic and treatment variables. The odds ratio of patients treated with TIF developing an infection compared to those treated with an ex-fix was 0.29 (95% CI 0.03 to 3.01).Conclusion: TIF of type IIIB open diaphyseal tibial fractures appears to be a safe alternative to conventional external fixation. Level of Evidence: Therapeutic Level III

Two-Stage Combined Ortho-Plastic Management of Type IIIB Open Diaphyseal Tibial Fractures Requiring Flap Coverage: Is the Timing of Debridement and Coverage Associated With Outcomes?

“…External fixation as a temporizing measure has ceased to exist as part of the novel ortho-plastic protocol in the study unit. [9] This has been the case since May 2015, one year prior to the end period of the study. Patients prior to this novel protocol received external fixation.…”

“…Use of the plate is a very simple technique that encourages adequate exposure of the zone of injury. [9,12] All wounds, regardless of type of temporary fixation, were dressed with negative pressure wound therapy (NPWT) and this is not removed until the second stage. Following stage one, the patient is physiologically stabilised until definitive fixation and soft tissue coverage, This is then undertaken on a dedicated ortho-plastics operating list.…”

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

“…reported that the infection rate was significantly lower in patients in whom the wound was closed within 5 days of the injury [ 7 ]. Nevertheless, only a limited number of reports have evaluated how to cover lost soft tissue to increase the success rate of reconstruction [ 11 , 12 ]. While treatment with antibiotics is recommended 24–72 h after wound closure [ 13 ], only a few reports have focused on antibiotic prophylaxis in open fractures [ 8 , 13 – 15 ].…”

Plate-Assisted Intramedullary Nailing of Gustilo Type IIIB Open Tibial Diaphyseal Fractures: Does Adjunctive Plate Retention Affect Complication Rate?

“…Bone ends are delivered, debrided and irrigated with a minimum of 5 litres of normal saline. The fracture is provisionally stabilised using a 3.5mm dynamic compression plate (DCP) as temporary internal fixation (TIF) (13). This is applied with transcoritcal screw fixation most commonly to the anteriomedial tibia.…”

“…Control and Prevention (CDC) for 'deep incision surgical site infection', see Figure , Supplemental Digital Content 1, http://links.lww.com/JOT/A985 (16). The definition was not reliant on positive cultures, and assumed that any surgical debridement, revision or antibiotic use within this cohort was indicative of deep infection (3,13).…”