Factors affecting clinical outcomes after treatment of extra-articular open tibial fractures

Abstract

Background: Tibial fractures are the most common long bone fracture and are often associated with severe soft tissue and bone defects. The objectives of our study were to describe the management and clinical results of patients with extra-articular open tibial fractures and to identify factors associated with a poor functional outcome.

Methods: This study included 82 adults available for follow-up for over 1 year after surgery. According to the AO Foundation/Orthopedic Trauma Association fracture classification, 26 fractures were type 41 A, 34 were type 42, and 22 were type 43 A. In accordance with the Gustilo-Anderson classification system, 31 were type I, 19 were type II, and 32 were type III. Initial nerve injury was confirmed in 18 cases.

Results: Definitive fixation occurred at a mean of 6.73 days (range, 0-16 days) after the injury. Soft tissue reconstruction was as follows: primary closure with debridement, 50 patients; split-thickness skin graft, 5; perforator based rotational flaps, 10; and free flaps, 17. Complications occurred in 29 cases (35.4%): superficial infection, 5 patients; deep infection, 3; primary suture site skin necrosis, 7; partial flap necrosis, 4; malalignment, 7; joint stiffness, 2; and hardware breakage, 1. Thirty additional operations (36.6%) were performed during the hospital stay. Mean bone union time was 20.4 weeks (range, 13-63 weeks) and the mean Lower Extremity Functional Scale score (LEFS) was 70.93 (range, 36-79). Multiple linear regression analysis indicated that skin defect size (p = 0.002), and occurrence of complications (p < 0.001) correlated with the LEFS score.

Conclusion: Functional outcome after treatment of extra-articular open tibial fractures was influenced by the skin defect size and the presence of any complications. This suggests that good clinical results can be expected if complications are prevented through proper reduction, firm fixation, early soft tissue reconstruction, and early rehabilitation.