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. 2013 Aug;8(2):133-40.
doi: 10.1007/s11751-013-0160-0. Epub 2013 Apr 21.

Conversion of open tibial IIIb to IIIa fractures using intentional temporary deformation and the Taylor Spatial Frame

H Sharma  1 , T Nunn
Affiliations

Conversion of open tibial IIIb to IIIa fractures using intentional temporary deformation and the Taylor Spatial Frame

H Sharma et al. Strategies Trauma Limb Reconstr. 2013 Aug.

Abstract

The closure of small-to-moderate-sized soft tissue defects in open tibial fractures can be successfully achieved with acute bony shortening. In some instances, it may be possible to close soft tissue envelope defects by preserving length and intentionally creating a deformity of the limb. As the soft tissue is now able to close, this manoeuvre converts an open IIIb to IIIa fracture. This obviates the need for soft tissue reconstructive procedures such as flaps and grafts, which have the potential to cause donor-site morbidity and may fail. In this article, the authors demonstrate the technique for treating anterior medial soft tissue defects by deforming the bone at the fracture site, permitting temporary malalignment and closure of the wound. After healing of the envelope, the malalignment is gradually corrected with the use of the Taylor Spatial Frame. We present two such cases and discuss the technical indications and challenges of managing such cases.

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Figures

Fig. 1
Fig. 1
Open fracture distal tibia post-stabilisation with a bridging external fixator
Fig. 2
Fig. 2
Two wounds, the smaller one communicated directly with the fracture site
Fig. 3
Fig. 3
Mattress sutures to close the smaller wound that communicated with the fracture
Fig. 4
Fig. 4
Waiting for the soft tissue envelope to heal. The intentional varus and recurvatum are seen with the TSF in situ. a Clinical picture. b, c AP & Lateral view of the intentional deformity
Fig. 5
Fig. 5
Radiographic position following solid union
Fig. 6
Fig. 6
Clinical picture 1 year following injury
Fig. 7
Fig. 7
Temporary skeletal stabilisation of an open tibial fracture extending into the ankle joint. Note the typical features of multiple exostoses
Fig. 8
Fig. 8
Large medial wound prior to deformation
Fig. 9
Fig. 9
Medial wound closure, with intentional varus and recurvatum deformity present
Fig. 10
Fig. 10
Frame with intentional deformity as seen from the front. a Clinical picture. b, c AP views showing intentional deformity
Fig. 11
Fig. 11
Sequential AP radiographs of the distal tibia with the frame in situ showing progressive fracture consolidation
Fig. 12
Fig. 12
Radiographic position following solid union
Fig. 13
Fig. 13
Clinical picture 18 months following injury
See this image and copyright information in PMC

References

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