Open tibial shaft fractures requiring flap coverage: the impact of orthoplastic reconstruction on outcomes

Al-Hourani, Khalid

Abstract

Introduction
Open tibial shaft fractures requiring soft tissue coverage (Gustilo-Anderson type IIIB) have been associated with unacceptably high deep infection rates. There remains considerable variation in orthoplastic management. The aim of this thesis was to evaluate the effect of a standardised two-stage orthoplastic protocol in the management of type IIIB open tibial fractures requiring flap coverage, with a primary outcome of deep infection rate.
Methods
This thesis consists of nine peer-reviewed research articles. The two-stage orthoplastic protocol was analysed. For studies from the study unit, retrospective analysis was undertaken from a main database for clinical/functional outcomes between May 2014 and January 2018. For studies where established literature was present, a systematic review and meta-analysis was undertaken for the variable studied.
Results
Deep infection rate ranged from 7.1%-8.9% in all studies. In those who did and did not experience an infection, there was no difference when devitalised bone was retained, or if temporary plate was retained. On meta-analysis, debridement earlier than 12 hours and use of definitive intramedullary nail was associated with lower complication rates. Time from definitive fixation to definitive flap cover of upto 2 days was associated with a lower infection rate compared to delay greater than 2 days.
Conclusion
The novel two-stage orthoplastic was not associated with inferior clinical or functional outcomes. It also appears as though a time to debridement of less than 12 hours and definitive intramedullary nailing is associated with a lower deep infection rate. Additionally, a single-stage “fix and flap” approach is associated with a lower deep infection rate, however a delay of up to 2 days between definite fixation and soft tissue cover appears safe. These results should be considered within the strict context of an orthoplastic approach.

Citation

Al-Hourani, K. Open tibial shaft fractures requiring flap coverage: the impact of orthoplastic reconstruction on outcomes. (Thesis by Publication). Edinburgh Napier University

• Thesis Type: Thesis by Publication
• Deposit Date: Sep 5, 2024
• Publicly Available Date: Sep 5, 2024
• DOI: https://doi.org/10.17869/enu.2024.3789482
• Award Date: Jul 5, 2024