Clinical Experiences for Open Fractures of Tibia

Sung, K L; Rah, S K; Choi, C U; Kim, H H

Abstract

The aims of treatment for the open fractures are to promote primary wound healing and union of the fractured bone. Seventy five cases of open tibial fractures in adult were treated from June 1975 to December 1980 at Soon Chun Hyang College Hospital. The results were analysed and discussed in this paper. The following data were obtained which were evaluated in following catagories: the causes, the sex and the age, the role of infection, the influence of concomitant fibular fracture and the emphasis on authors treatment of different types of the open tibial fractures. 1. The most common cause of the open tibial fractures was traffic accidents. 2. The fractures were 10 times more prevalent in male than female, they frequently occurred in third to fifth decades (about 90%). The average duration of bone union was not different among the age groups except old age (over 60 years old) which were delayed for about 6 weeks. 3. The evaluation of open tibial fractures was done according to Gustilos classification-type 3 fractures showed the worst prognosis. 4. The wounds were treated with rather broad debridement and primary closure in type 1, 2; delayed or secondary closure in type 3. The primary wound healing rates were 34 cases out of 37 cases in type one, 25 cases out of 33 cases in type two and 1 out of 5 in type three open tibial fractures. 5. The group which was associated with fibular fracture had the longer duration in bone union time, the lower primary union rate and the higher occurrance of complications than the group without fibular fracture. 6. The overall infection rate was 20%. The bony union of the infected open tibial fractures were delayed about 10 weeks longer than non-infected ones and the only 6.6% of the infected had the primary bony union within 20 weeks. 7. The good result was obtained in type 1 fractures, by using the pin and plaster method and then followed by early weight bearing with PTB cast; in type 2, compared with open reduction and internal fixation, manual reduction and long leg cast immobilization was preferable. Type 3 open tibial fractures showed no difference in result between the treatments by surgical or by conservative measures.