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?

OBJECTIVE: To delineate whether timing to initial debridement and definitive treatment had an effect on patient outcomes in those undergoing two-stage ortho-plastic management of Gustilo-Anderson type IIIB open tibial diaphyseal fractures.

DESIGN: Retrospective comparative cohort study over a two year period.

SETTING: Level 1 trauma centrePatients/Participants: A total of 148 patients were identified. Following exclusion of ankle fractures, non-diaphyseal fractures and those who did not undergo two-stage ortho-plastic management, 45 patients were eligible for final analysis.

INTERVENTION: Time to initial debridement and definitive management MAIN OUTCOME MEASUREMENT:: Deep infection. Secondary outcomes being nonunion and flap failure. Multiple linear regression was utilised for outcomes. We assumed a priori that p values of less than 0.05 were significant.

RESULTS: Mean age was 54 years (SD 23.0), with 28 males and 17 females. Over a mean 2 year follow up, there were four (4/45) deep infections, two infection associated flap failures and one vascular flap failure. All patients progressed to union. The mean time to initial debridement for the whole cohort was 19 hours (SD 12.3), and the mean time to definitive reconstruction was 65 hours (SD 51.7). Longer time to both initial debridement and definitive reconstruction was not found to be significantly associated with deep infection, infected flap failure or nonunion.

CONCLUSION: Utilising a two-stage ortho-plastic operative algorithm, timing to initial debridement and definitive fixation with soft tissue coverage was not associated with negative outcomes.