Orthoplastic Management of Lower Limb Traumas: A Retrospective Study on Polytraumas Versus Isolated Injuries

Area of Science:

• Orthoplastic surgery
• Trauma management
• Limb reconstruction

Background:

• Open lower limb fractures pose significant challenges in trauma care.
• Adherence to established guidelines for managing these fractures can be inconsistent.
• The impact of polytrauma on orthoplastic approach adherence requires further investigation.

Purpose of the Study:

• To evaluate the influence of polytrauma on adherence to timing and management protocols in the orthoplastic approach for open lower limb fractures.
• To compare the outcomes of orthoplastic management between patients with polytrauma and those with isolated lower limb fractures.

Main Methods:

• Retrospective review of 36 patients with Gustilo-Anderson grade IIIA, IIIB, or IIIC open lower limb fractures (2018-2022).
• Analysis of key management metrics: time to plastic surgeon evaluation, soft tissue coverage, definitive osteosynthesis, ICU stay, hospitalization duration, and costs.
• Patient satisfaction assessed using the Enneking and Foot Function Index (FFI) questionnaires.

Main Results:

• Soft tissue reconstruction was needed in 63.9% of patients; 56.5% were polytrauma (PT) and 43.5% isolated lower limb fracture (ILLF).
• PT group had significantly shorter mean time to soft tissue coverage (15.0 days vs. 38.0 days).
• No significant differences observed in time to plastic surgeon involvement, fixation, hospitalization, costs, or patient-reported outcomes (Enneking, FFI).

Conclusions:

• Open lower limb fracture management via an orthoplastic approach appears more effective in polytrauma patients.
• The mandatory multidisciplinary approach in polytrauma patients likely contributes to improved outcomes.
• This study is the first to compare orthoplastic approach effectiveness between isolated lower limb fractures and polytraumas.