One-stage combined fix and flap approach for complex open Gustilo-Anderson IIIB lower limbs fractures: a prospective review of 102 cases

Background Management of open fractures is challenging and requires a multidisciplinary team approach. This study aims to evaluate outcomes of open Gustilo-Anderson IIIB fractures managed at a single Ortho-Plastic centre following One-stage Fix and Flap approach. Methods Prospective data review for patients presenting with Gustilo-Anderson IIIB Fractures to our centre and managed with one-stage Fix and Flap approach. Postoperative outcomes are presented only for the patients who had a minimum of 12 months postoperative follow-up. Results 120 patients were included (83 males and 37 females). Mean age was 43 years (10-96). Tibia diaphysis was the most common site of injury (60%). 55.9% of injuries were road traffic accidents (RTA). 102 out of 120 patients had a minimum of 12 months follow-up (mean follow-up duration 25 months). Meantime from injury until definitive surgery was 7.71 days. Primary union achieved in 86.73%. Delayed union was encountered in 10.20%. 3.06% of patients had non-union. Limb salvage rate was 97.05% and Deep infection rate was only 0.98%. Conclusion Our results showed that low infection rate, high limb salvage rate, and high union rate can be achieved in these complex injuries with meticulous technique, combined Ortho-Plastic (Fix and Flap) approach, and MDT input.

Automated summary

This study demonstrated that low infection rate, high limb salvage rate, and high union rate can be achieved in open Gustilo-Anderson IIIB fractures through meticulous technique, combined Ortho-Plastic (Fix and Flap) approach, and multidisciplinary team input.