Study to evaluate the outcome of soft tissue reconstruction in case of open tibia fractures

Materials and Methods: This is prospective study of minimum 30 patients admitted to East point College of Medical Sciences and Research Centre. Thorough local examination of injured limb was done and fracture graded according to Gustilos grading of fracture. Post debridement grading and radiological evaluation of fracture was recorded. Wound management was decided as per the condition of the patient and wound contamination-acute (<1 week), subacute (1-6 weeks), chronic (>6 weeks). Fracture management included external fixation, IM fixation, plate fixation (Internal fixation), limited internal fixation-pin/K-wire/Screws, and pin plaster. Type of coverage was planned-Split thickness skin grafting; fasciocutaneous flap, Muscle flap and SSG.

Results: Majority of the patients were found in age group between 21-30 years and least was in the age group of below 10 years. It was observed that majority of patients in our study were male (86.66%). RTA was the main mode of injury with 27 cases (90%). Out of 15 patients, 4 had head injury (13.33%), 5 had blunt abdomen trauma (16.66%), 4 patients had both head injury and blunt abdomen trauma (13.33%) and 2 patients had urinary bladder rupture (6.66%). Oblique fracture was found in 15 patients (50%), spiral in 10 cases (33.33%) and comminuted fracture in 5 cases (16.66%). Majority of patients underwent external fixation i.e. 17 cases (56.66%) followed by Internal fixation i.e.11 cases (36.66%). In this study excellent results were observed in 23 cases (76.66%), good in 5 cases (16.66%) and poor in 2 cases (6.66%).

Conclusion: Early soft tissue coverage in the acute phase (1-6 days) should be the priority in order to prevent bacterial colonisation especially hospital acquired; wound desiccation, sequestration of the exposed bone. External fixation should be contemplated in highly comminuted fractures with severe contamination and when wound closure is not possible.