[Open fractures of the leg - Series from the University Hospital of Nancy].

Abstract

Thirteen cases from two teams were studied retrospectively between 1983 and 1992. There were 11 men and 2 women with an average of 30 years (16-52 years). Nine were due to road traffic accidents and in 3 cases the fracture involved the upper third, 5 cases the middle third and 5 cases the lower third of the tibia. Six patients suffered from multiple injuries. Arteriography was used in 6 cases. Initial debridement was adequate in 9 cases but required to be redone in 3. In one case it required to be repeated several times. Antibiotics were given for an average of 28 days but if 2 infected cases are withdrawn antibiotics were only given for 11 days. Fixation was by external fixator in all cases except for one which was placed on traction. In 4 cases the external fixator required to be changed secondarily. Skin cover was obtained by 6 latissimus dorsi free flaps, one free inguinal flap and 2 local flaps of tibius anterior and medial gastrocnemius. Four free posterior iliac crest transplants and one free fibula were done between the 12th day and 2nd month after injury. Additional bone was added in 3 cases by a conventional cortico-cancellus graft done secondarily. Each patient had an average of 6 operations (3-17). The length of hospitalisation was an average of 3 months (1-6 months).Consolidation took on average 12 months (6-27). There were no necroses of skin flaps. Five non-unions were treated by a secondary bone graft and changing the fixator. One infected non-union was treated successfully by the Ilizarov method. One amputation because of osteomyelitis resulted from the latissimus dorsi flap which was done too late. There were 4 cases of pes cavus with toe clawing and one ankle joint became completely stiff.The overall results are comparable to those of the S.O.T.EST Round Table. Return to work was on average 20 months (9-42) either with or without change in occupation.This series is characterised by the systematic use of an external fixator and by the number of latissimus dorsi free flaps (6) to obtain cover and liberal use of bone grafts to ensure consolidation. The authors emphasise that early flap cover before the 21st day saves time by avoiding trophic changes and led to consolidation in an average of 9 months compared to 12 months for the overall series.