Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 1;38(8):447-451.
doi: 10.1097/BOT.0000000000002841.

Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center

Kiran R Madhvani  1 , Angus Fong, Thomas Clark, Khemerin Eng, Codrin Condurache, Jonathan McGregor-Riley, David W Shields
Affiliations

Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center

Kiran R Madhvani et al. J Orthop Trauma. .

Abstract

Objectives: The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo-Anderson 3B open tibial fractures.

Design: A prospectively maintained database was retrospectively interrogated.

Setting: Single major trauma center in the United Kingdom.

Patient selection criteria: All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors.

Outcome measures and comparisons: The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions.

Results: Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases.

Conclusions: Orthoplastic care including circular frame fixation for Gustilo-Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%).

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Cui Z, Yu B, Xu C, et al. Unreamed intramedullary nailing versus external fixation for type IIIA and IIIB open fractures of tibial shaft: a subgroup analysis of randomized trials. J Nov Physiother. 2013;03:144.
    1. Tornetta P, Bergman M, Watnik N, et al. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76:13–19.
    1. Karladani AH, Granhed H, Karrholm J, et al. The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Archives Orthop Trauma Surg. 2001;121:325–328.
    1. Blair JA, Stoops TK, Doarn MC, et al. Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma. 2016;30:392–396.
    1. Major Extremity Trauma Research Consortium METRC. Modern external ring fixation versus internal fixation for treatment of severe open tibial fractures: a randomized clinical trial (FIXIT study). J Bone Joint Surg Am. 2022;104:1061–1067.