Immediate Internal Fixation of Long Bone Open Fractures: A Review of 80 Cases
10.4055/jkoa.1990.25.6.1681
- Author:
Han Koo LEE
;
Sung Il KIM
;
Young In LEE
- Publication Type:Original Article
- Keywords:
Open fractures;
Immediate internal fixation;
Complications
- MeSH:
Amputation;
Bone Transplantation;
Classification;
Coinfection;
Congenital Abnormalities;
Femur;
Follow-Up Studies;
Forearm;
Fractures, Closed;
Fractures, Open;
Humans;
Humerus;
Joints;
Osteomyelitis;
Soft Tissue Infections;
Tibia;
Transplants;
Vascular System Injuries;
Wounds and Injuries
- From:The Journal of the Korean Orthopaedic Association
1990;25(6):1681-1690
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Eighty long bone open fractures were treated with immediate internal fixation within an average of 7.4 hours after trauma from June, 1984 to September, 1989. Mean follow-up was 17 months ranging from 1 year to 3 years and 4 months. Fifty-four tibia, 11 femur, 9 forearm, and 6 humerus open fractures were encountered. According to Gustilo and Anderson's wound classification, there were 19 Type I, 26 Type II, and 35 Type III open fractures. Internal fixation was facilitated with plate and screws in 58 cases, Ender nails in 13 cases, Kuntscher nails in 3 cases, and screws only in 5cases. Bone grafting was performed in 47 cases. Uncomplicated union was achieved in 16cases (84 %) in type I, 23 cases (88%) in Type II, and 18 cases (51%) in Type III. Transient soft tissue infection was noted in 3 cases(16%) in Type I, 3 cases(8%) in Type II, and 5 cases(14%) in Type III. Transient osteomyelitis was present in 1 caes(4%) in Type II, and 4 cases(11%) in Type III, and all were resolved within 1 month. Three cases of Type III open fractures where mutilated injury was associated with severe vascular injuries were ended up with amputation. Five unions (14%) in Type III were complicated with chronic osteomyelitis. Overall uncomplicated union was achieved in 38 cases (87%) in Type I & II, and 18 cases (51%) in Type III. Soft tissue coverage especially with viable muscle and stable fixation with good cortical contact seemed to be important prognostic factors. While there exists potential disadvantages of higher minor and major complication rates and more sophisticated management of the patient, this one-stage open reduction and internal fixation with bone graft which converts open fracture into stable closed fracture might be of some value especially in Type I & II open fractures in terms of simultaneous management of fracture and open wound, prevention of secondary infection, anatomical reduction including joint congruity, stable maintenance of reduction, elimination of deformity, and early joint motion.
