Treatment of III B open tibial fractures with early osteosynthesis and local muscle flaps

From 1986 to 1994 18 patients with 19 IIIB open tibial fractures were treated following similar therapeutic management. This included early and radical primary debridement, early and whereever possible immediate internal fixation of the bone and coverage with a local muscle flap (hemisoleus or gastrocnemius). At the time of follow-up all fractures had consolidated clinically as well as radiographically. The mean time to bony union was 7 months (3-20). Twelve patients did not have any severe pain and were able to walk for more than 4 km. The time to return to work averaged 8 months. In 2 cases a permanent disability of 50% was established. Fourteen of 18 patients were satisfied with the function of the leg. On the other hand, 9 didn't like the aesthetic appearance and were inhibited because of it. The following complications occurred within a period of 2 years: non-union (3), flap necrosis (2), osteomyelitis (2), delayed union (4). The mean number of reoperations was 3 (0-8). In no case did an amputation have to be performed.