Successful limb salvage in femoral fracture of Gustilo type ⅢC / 中华创伤骨科杂志

ABSTRACT

Objective:To report our experience in successful limb salvage in 2 cases of femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours.Methods:From February 2016 to April 2017, 2 patients with femoral fracture of Gustilo type ⅢC were treated at The Great Wall Orthopaedic and Hand Surgery Hospital after warm ischemia beyond 10 hours.Both of them were male, 42 and 27 years of age.After debridement, bone shortening for 8.0 cm and 10.0 cm respectively was followed by replantation. The fractures were fixated end to end with a compression plate, the femoral artery was anastomosed directly and the muscles were sutured end to end.Secondary osteotomy was conducted 4 months after successful replanta-tion, followed by unilateral external fixation for reconstruction.Limb lengthening began one week after sec-ondary osteotomy.The efficacy was assessed by the Paley criteria.Results:Scattered irregular necrosis occurred in the leg muscles but was cured by dermatoplasty through a decompressive incision 40 days after debridement for 4 times.The affected limbs in the 2 cases were successfully saved and lengthened to the same length as the opposite one.The limbs were lengthened for 8.0 and 10.0 cm and for 3.0 and 3.5 months, respectively.The unilateral external fixator was worn for 29 and 24 months, respectively.The plantar sensation recovered to S4 one year after operation.Follow-up at 6 months after removal of external fixation showed excellent bony outcomes and good functional outcomes in both cases According to the Paley criteria.Conclusion:For femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours, thorough debridement, plate fixation, bone shortening and replantation at one stage, followed by secondary limb lengthening using unilateral external fixation, may be practical and effective procedures, as long as in-dications for limb salvage should be comprehensively followed.