SEVERE OPEN TIBIAL FRACTURES TREATED WITH THE ‘FLAP AND FRAME’ TECHNIQUE

Purpose of Study We intended to determine our rates of deep infection and non-union in severe open tibial fractures treated at our institution with Ilizarov frames. Methods We retrospectively reviewed the case notes and radiographs of sixty consecutive cases of severe (Gustillo-Anderson Grade III) open fractures of the tibia treated in our tertiary referral unit with the ‘Flap and Frame’ technique. This technique involves early aggressive soft tissue and bone debridement and temporary skeletal stabilisation, followed by soft tissue coverage and then, when the soft tissues have settled, definitive skeletal stabilisation with the Ilizarov frame. The primary outcome measures were the presence of deep infection, occurence of union with the index frame, and any requirement for secondary amputation. Results Mean average age was 43.3 years (range 16–89). None had neurovascular injuries requiring repair, while three quaters required soft tissue coverage procedures. Half of the fractures had significant bone loss following debridement, with a mean average loss of 28.1 mm (range 5–125). Mean followup was 10.3 months. The deep sepsis rate was 1.7 percent, or 5 percent including cases with significant soft tissue infection but no confirmed bone infection, with a 5 percent non-union rate. Conclusion In our centre management of severe open fractures of the tibia treated with the ‘Flap and Frame’ technique, with Ilizarov, fixation achieves rates of deep infection and union which compare favourably with previously reported results.