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Use of a Defined Surgical Approach for the Debridement of Open Tibia Fractures

Marecek, Geoffrey S. MD*; Nicholson, Luke T. MD*; Auran, Richard T. MD; Lee, Jackson MD*

Journal of Orthopaedic Trauma: January 2018 - Volume 32 - Issue 1 - p e1–e4
doi: 10.1097/BOT.0000000000000998
Original Article
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Objectives: To determine whether a defined approach for debridement of open tibia fractures would result in no change in reoperation rate, but reduce the need for flap coverage.

Design: Prospective cohort study.

Setting: Academic Level 1 trauma center.

Patients: A total of 66 patients with 68 open diaphyseal tibia fractures were included. Patients under the age of 18 and with orthopaedic trauma association open fracture classification (OTA-OFC) skin score of 3 were excluded.

Intervention: Debridement of the open fracture through direct extension of the traumatic wound or through a defined surgical interval.

Main Outcome Measurements: Number of operations. Need for soft-tissue transfer.

Results: A total of 47 patients had direct extension of the traumatic wound and 21 patients had a defined surgical approach. The groups had similar proportions of Gustilo–Anderson and OTA-OFC subtypes. The average number of surgeries, including index procedure, per patient was 1.96 in the direct extension group and 1.29 in the defined approach group (P = 0.026). Flap coverage was needed in 9 patients in the direct extension group and no patients in the defined approach group (P = 0.048).

Conclusions: A defined surgical approach to the debridement of open tibia fractures is safe and may reduce the need for flap coverage in select patients.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA; and

Department of Orthopaedic Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ.

Reprints: Geoffrey S. Marecek, MD, 1200 N. State St, GNH 3900, Los Angeles, CA 90033 (e-mail: marecek@usc.edu).

G. S. Marecek is a consultant for Globus Medical and ETEX. The remaining authors report no conflict of interest.

Presented in part at Western Orthopaedic Association Annual Meeting, August 1, 2015, Coeur d'Alene, Idaho, and as posters at the Annual Meeting of the Orthopaedic Trauma Association, October 6–8, 2016, National Harbor, MD, and the American Academy of Orthopaedic Surgeons meeting, March 14–18, 2017, San Diego, CA.

Accepted July 27, 2017

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