Immediate reconstruction of Gustilo grade-Ⅲ long bone fractures caused by high energy:29 patients / 中国矫形外科杂志

ABSTRACT

[Objective]To report the clinical results of immediate reconstruction of open grade Ⅲ long bone fractures caused by high-energy.[Method]From Jan.2001 to Jul.2006,vascular flaps were applied in 29 patients suffering from massive limb trauma,complicated by Gustilo grade-Ⅲ open fractures(11 were type B,and 18 type C) and massive soft tissue defects,caused by high-energy,through an emergency procedure.Meanwhile,vessels and nerves were repaired,broken bones and tendons were reconstructed.The mean MESS(Mangled extremity severity score) score was 6.27(6.27?2.43).[Result]All limbs were salvaged and all the flaps survived without protracted course to obtain soft tissue coverage.The mean hospital stay was 23 days(12-67 days) and the follow-up ranged 14 to 58 months(mean 26 months).No severe complication occurred,including wound infection,bone nonunion,necrosis and morbidity.The ultimate functional results of the salvaged limbs were at least better than artificial limbs.[Conclusion]The immediate reconstruction of severely injured limbs complicated by Gustilo type Ⅲ fractures caused by high energy has the advantages over traditional methods.This technique enables controlling bone,soft tissue and other problems together through an emergency procedure with a relatively shortened in-hospital stay and less fibrosis,thereby favoring the functional outcome.Early wound healing favors antibiotic diffusion and local blood supply.It may be an alternative for fast fixation and better bone healing.