Management of open tibial fractures - a regional experience

• Published in: Annals of the Royal College of Surgeons of England Vol. 92; no. 8; pp. 693 - 696
• Main Authors: Townley, W A, Nguyen, D Q A, Rooker, J C, Dickson, J K, Goroszeniuk, D Z, Khan, M S, Camp, D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2010; The Royal College of Surgeons of England
• Subjects: Accidents, Traffic; Adolescent; Adult; Aged; Aged, 80 and over; Amputation; Child; England; Female; Fracture Fixation - methods; Fractures; Fractures, Open - etiology; Fractures, Open - surgery; Hospitals; Humans; Injuries; Interdisciplinary aspects; Length of Stay - statistics & numerical data; Male; Medical Audit; Medical referrals; Middle Aged; Patients; Plastic surgery; Postoperative Complications; Prospective Studies; Reconstructive Surgical Procedures - methods; Surgeons; Surgical Flaps; Tibial Fractures - etiology; Tibial Fractures - surgery; Trauma; Trauma Severity Indices; Trauma Surgery; Treatment Outcome; Wales; Young Adult; England; Wales; United Kingdom > UK
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588410X12699663904592

The treatment of soft-tissue injuries associated with tibial diaphyseal fractures presents a clinical challenge that is best managed by a combined plastic and orthopaedic surgery approach. The current study was undertaken to assess early treatment outcomes and burden of service provision across five regional plastic surgery units in the South-West of England. We conducted a prospective 6-month audit of open tibial diaphyseal fracture management in five plastic surgery units (Bristol, Exeter, Plymouth, Salisbury, Swansea) with a collective catchment of 9.2 million people. Detailed data were collected on patient demographics, injury pattern, surgical management and outcome followed to discharge. The study group consisted of 55 patients (40 male, 15 female). Twenty-two patients presented directly to the emergency department at the specialist hospital (primary group), 33 patients were initially managed at a local hospital (tertiary group). The mean time from injury to soft tissue cover was significantly less (P < 0.001) in the primary group (3.6 ± 0.8 days) than the tertiary group (10.8 ± 2.2 days), principally due to a delay in referral in the latter group (5.4 ± 1.7 days). Cover was achieved with 39 flaps (19 free, 20 local), eight split skin grafts. Nine wounds closed directly or by secondary intention. There were 11 early complications (20%) including one flap failure and four infections. The overall mean length of stay was 17.5 ± 2.8 days. Multidisciplinary management of severe open tibial diaphyseal may not be feasible at presentation of injury depending on local hospital specialist services available. Our results highlight the need for robust assessment, triage and senior orthopaedic review in the early post-injury phase. However, broader improvements in the management of lower limb trauma will additionally require further development of combined specialist trauma centres.