Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team

J Orthop Trauma. 2017 Jun;31(6):339-344. doi: 10.1097/BOT.0000000000000815.

Abstract

Objectives: To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team.

Design: Retrospective cohort study.

Setting: A single level 1 trauma center.

Patients: Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015.

Intervention: Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team.

Main outcome measure: Time from index injury to flap coverage.

Results: The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23).

Conclusions: After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Fracture Healing
  • Fractures, Open / diagnosis
  • Fractures, Open / surgery*
  • Humans
  • Male
  • Microsurgery / methods*
  • Middle Aged
  • Retrospective Studies
  • Soft Tissue Injuries / diagnosis
  • Soft Tissue Injuries / surgery*
  • Surgical Flaps / transplantation*
  • Tibial Fractures / diagnosis
  • Tibial Fractures / surgery*
  • Treatment Outcome
  • Young Adult