[Treatment by external fixator of open Gustilo stage III A and III B leg fractures]

From June 1992 to July 1993, we treated 10 consecutive open tibial fractures (6 III A and 4 III B according to the classification of Gustilo). All fractures were treated by external fixation (9 Hoffmann external fixators and 1 Orthofix). Only one patients needed a primary facsiocutaneous flap; the remaining patients were treated by skin grafting (7 cases), secondary wound (1 cases) and granulation (1 case). In 8 cases we realised a decortication and autologous bone grafting. Consolidation time was inferior or equal to 6 months in 5 patients, equal to 8 months in one and equal to 11 months in one. One patient was lost to follow-up and one ist still in treatment. In 2 patients we changed the stabilisation system and we used the Ilizarov technique, once for pseudoarthosis at 7.5 months from injury and once for bone-transfer at 3.5 months. We do not deplore any other case of pseudoarthrosis nor any case of osteitis. None of our patients needed amputation. Early and adequate soft tissue treatment is essential and decoration and bone grafting, which we used 8 times at mean of 12 weeks from injury, should be done earlier.