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Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure
Malcolm R DeBaun1, L Henry Goodnough, Krystin A Hidden
1From the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC (DeBaun), the Department of Orthopaedic Surgery, Stanford Medicine, Stanford, CA (Goodnough), the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Hidden), and the Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA (Nork, Kleweno, and Hebert-Davies).
Objective:
The purpose of this study was to determine whether type III open high-energy tibia fractures treated with immediate intramedullary nailing (IMN) and primary closure yield low rates of flap coverage.
Methods:
Patients with high-energy type IIIA open tibia (OTA/AO42/43) fractures treated with IMN over a 10-year period at a level 1 academic center with at least 90 days of in-person postoperative follow-up were included. Single-stage reamed IMN with acute primary skin closure using Allgower-Donati suture technique was utilized in patients without notable skin loss. The primary outcome was treatment failure of acute primary skin closure requiring subsequent soft-tissue coverage procedures.
Results:
A total of 111 patients with type IIIA tibia fractures met inclusion criteria. Of 107 of the 111 patients (96%) with skin closure at the index surgery, 95 of the 107 patients (89%) healed their soft-tissue envelop uneventfully. Among the patients who failed primary closure (11%), five required free tissue transfers, five required local rotational flaps, and two underwent split thickness skin grafting only. Patients who failed acute primary closure declared within an average of 8 weeks postoperatively.
Discussion:
Treatment of type IIIA open high-energy tibia fractures with immediate IMN and primary closure using meticulous soft-tissue handling yields low rates of flap coverage.
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