Does the Zone of Injury in Combat-Related Type III Open Tibia Fractures Preclude the Use of Local Soft Tissue Coverage?
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Objectives Does the large zone of injury in high energy, combat related open tibia fractures limit the effectiveness of rotational flap coverage Design Retrospective consecutive series. Setting This study was conducted at Brooke Army Medical Center, Walter Reed Army Medical Center, and National Naval Medical Center between March 2003 and September 2007. PatientsParticipants We identified 67 extremities requiring a coverage procedure out of 213 consecutive combat related Type III open diaphyseal tibia fractures. Intervention The 67 Type III B tibia fractures were treated with rotational or free flap coverage. Main Outcome Measures Flap failure, reoperation, infection, amputation, time to union, and visual pain scale. Results There were no differences between the free and rotational flap cohorts with respect to demographic information, injury characteristics, or treatment before coverage. The reoperation and amputation rates were significantly lower for the rotational coverage group 30 and 9 compared with the free flap group 64 and 36 P 0.05 and P 0.03, respectively. The coverage failure rate was also lower for the rotational flap cohort 7 vs 27, p 0.08. The average time to fracture union for the free flap group was 9.5 months range, 5 15.8 months and 10.5 months range, 3-41 months for the rotational flap group p99. Conclusions There was a significantly lower amputation and reoperation rate for patients treated with rotational coverage. Contrary to our hypothesis and previous reports, the zone of injury in combat related open tibia fractures does not preclude the use of local rotational coverage when practicable.
- *BONE FRACTURES
- *SOFT TISSUES
- *WOUNDS AND INJURIES
- COMBAT AREAS
- MILITARY MEDICINE
- MILITARY PERSONNEL
- PHYSIOLOGICAL EFFECTS
- Anatomy and Physiology
- Medicine and Medical Research
- Military Forces and Organizations