Orthoplastic approach to infected type 3B open tibial fractures: Management and complications

This study aimed to describe the surgical strategies, the patterns of complications, and their subsequent management in patients with infected Gustilo-Anderson type 3B open tibial fractures.

A retrospective chart review was conducted for the period between January 2010 and January 2024 at a single institution. A total of 27 patients with infected Type 3B tibial fractures were eligible for inclusion in the final analysis. The diagnosis of infection was established by incorporating clinical parameters, including wound and discharge characteristics, odor, microbiological cultures, and inflammatory markers. Demographic and clinical data, including age, gender, mechanism of injury, and total follow-up duration, were recorded. Furthermore, the interval between interventions, the presence and dimensions of bone defects, and the specific fixation methods were analyzed. Time to osseous union was determined based on serial follow-up radiographs. Pathogen identification was performed through a review of culture results, and the specific tissue transfer techniques utilized for soft tissue coverage were documented. Additionally, all observed complications and the frequency and extent of secondary interventions were recorded.

Mean age was 34.3 (± 14.6) years. Median follow-up period was 27 (12-140) months. For soft tissue coverage, an anterolateral thigh flap was used in 14 cases (51.9%), local flaps in 4 cases (14.8%), osteocutaneous vascularized fibular grafts in 3 cases (11.1%), lateral arm flap in 2 cases (7.4%), sural artery flap in 2 cases (7.4%), latissimus dorsi flap in 1 case (3.7%), and superficial circumflex iliac artery perforator flap in 1 case (3.7%). A total of 31 complications were identified across the 27 patients. The most frequent complications were flap compromise and secondary infection, each occurring in 8 instances (25.8%), while nonunion was reported in 7 cases (22.5%). The median number of surgical interventions per patient was 7, with a range of 2-15 procedures.

Infected type 3B tibial open fractures are associated with high rates of complications and secondary interventions. Effective management of such complications is possible with broad range of soft tissue and bone reconstruction techniques.