Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center

Abstract

Objectives: The aim of this study was to report experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open tibial fractures. Methods: Design: A prospectively maintained database was retrospectively interrogated. Setting: Single major trauma centre in the United Kingdom. Patient Selection Criteria: All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study centre. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another centre, had pre-existing infection, sustained a periarticular fracture or those who did not afford a minimum of 12-months follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. Outcome Measures and Comparisons: The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. Results: 225 patients met inclusion criteria. Mean age was 43.2 years old, with 72% males, 34% smokers and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). 8 (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. 79 (35.1%) patients had a secondary intervention of which; 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. Conclusions: Orthoplastic care including circular frame fixation for GA-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.