Can an open displaced tibial fracture be treated without surgery? a treatment discussion: a case report

Authors

  • Sara Elisa Diniz Department of Orthopaedics, Centro Hospitalar do Porto – Hospital de Santo António, Largo Prof Abel Salazar, Portugal http://orcid.org/0000-0002-2386-5504
  • João Vale Department of Orthopaedics, Centro Hospitalar do Porto – Hospital de Santo António, Largo Prof Abel Salazar, Portugal
  • Pedro Neves Department of Orthopaedics, Centro Hospitalar do Porto – Hospital de Santo António, Largo Prof Abel Salazar, Portugal

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20211628

Keywords:

Open fracture, Tibial fracture, Soft tissues, Surgery, Conservative treatment

Abstract

The authors present a case of a 70-year-old female with left tibial open fracture (Gustillo-Anderson type II) with previous history of trauma of the same limb, from which resulted a Morel-Lavallée injury complicated with extensive tissue necrosis. Considering the sequel condition of soft tissues (scarring and extensive fibrosis), conservative treatment was taken and successful result was achieved. In this case the biggest concern was not the traumatic tissue damage caused by the fall, but the poor quality of tissues already existent before this event. Although surgical treatment is the gold standard in these cases, we must analyze case by case the risk benefit of each procedure and choose the one we believe is the best for the patient.

References

Mundi R, Chaudhry H, Niroopan G, Petrisor B, Bhandari M. Open Tibial Fractures: Updated Guidelines for Management. J Bone Joint Surg Rev. 2015;3(2),1.

Rockwood, Charles A. In: Bucholz RW, Heckman JD, CourtBrown CM, eds. Rockwood and Green's fractures in adults. 6th ed. United States, Philadelphia: Lippincott Williams & Wilkins. 2014.

Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The epidemiology of open fractures in adults: A 15-year review. Injury. 2012;43(6),891–7.

Thakore RV, Francois EL, Nwosu SK, Attum B, Whiting PS, Siuta MA et al. The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures. Europ J Traum Emerg Surg. 2016;43(5):651–6.

Duyos OA, Beaton-Comulada D, Davila-Parrilla A, Perez-Lopez JC, Ortiz K, Foy-Parrilla C et al. Management of Open Tibial Shaft Fractures. J Am Acad Orthopaed Surg. 2017;25(3):230–8.

Griffin M, Malahias M, Khan W, Hindocha S. Update on the management of open lower limb fractures. Open Orthop J. 2012;6:571-7.

Zalavras CG. Prevention of Infection in Open Fractures. Infectious Disease Clinics of North America, 2017;31(2):339–52.

Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg 1990;72-A:299-304.

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower limb open fracture wounds. A prospective randomized study. J Bone Joint Surg Am. 2005;87:1415-22.

Halawi MJ and Morwood MP. Acute Management of Open Fractures: An Evidence-Based Review. Orthopedics. 2017;38(11),1025–33.

Nanchahal J, Nayagam S, Khan U, Moran C, Barrett S, Sanderson F, et al, Standards for treatment of open fractures of the lower led. British Association of Reconstructive and Aesthetic Surgeons, United Kingdom, UK: Royal society of medicine press. 2009;1-108.

Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36-40.

Hauser CJ, Adams CA, Eachempati SR. Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline. Surgical Infections. 2006;7(4):379–405.

Scharfenberger AV, Alabassi K, Smith S, Weber D, Dulai SK, Bergman JW, et al. Primary Wound Closure After Open Fracture: A Prospective Cohort Study Examining Nonunion and Deep Infection. J Orthopaed Traum. 2017;31(3):121–6.

VandenBerg J, Osei D, Boyer MI, Gardner MJ, Ricci WM, Spraggs-Hughes A. Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopedic Trauma/Microsurgical Team. J Orthopaed Trau. 2017;31(6):339–44.

Nambi GI, Salunke AA, Thirumalaisamy SG, Babu VL, Baskaran K, Janarthanan T, et al. Single stage management of Gustilo type III A/B tibia fractures: Fixed with nail and covered with fasciocutaneous flap. Chin J Traumatol. 2017;20(2):99–102.

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Published

2021-04-26

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Section

Case Reports