Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures

Abstract

Objectives: 1) evaluate intentional temporary limb deformation for closure of soft tissue defects as a reconstruction strategy in open tibia fractures and 2) analyze the deformity parameters required for such reconstruction. Design: Multicenter retrospective cohort Setting: Level I trauma center Patients/Participants: Nineteen patients 18 years of age and older at time of initial trauma, with a Gustilo-Anderson type IIIB or IIIC open tibia fracture treated with hexapod external fixation and intentional bony deformity created to facilitate soft tissue closure. Intervention: Intentional limb deformation for soft tissue closure, followed by gradual correction with hexapod external fixator. Outcome Measurements: Radiographic healing, radiographic assessment of limb alignment, functional and bony ASAMI score. Results: The average age was 45.3 (20-70), and 79% of patients were male. The most common mechanism of injury was motor vehicle accidents. The distal 1/5 of the tibia was the most common fracture location, with 37% of these involving the articular surface at the plafond. After wound closure, deformity correction was initiated after 30 days on average. Varus and apex posterior were the most common initial deformity required for primary soft tissue closure. Bony and functional ASAMI outcomes were good or excellent in 94% of patients. Conclusion: Intentional deformation followed by gradual correction can be an effective strategy to obtain bone union and soft-tissue coverage in certain open fractures. This technique, in essence, converts these injuries from type IIIB to IIIA. This strategy obviates the need for flap coverage and results in satisfactory outcomes. Level of Evidence: Level III Therapeutic. See Instructions for Authors for a complete description of levels of evidence.