A prospective study of early soft tissue coverage of grade IIIB tibial fractures.
Between 1987 and 1990, 45 consecutive patients with grade III tibial injuries were treated by an established protocol. There were 31 men and 14 women. The average age was 27 years (range, 17-68 years). The average follow-up was 16 months (range, 12-46 months). Early bony fixation consisted of an external fixator in 28 patients and a non-reamed intramedullary nail in 17 patients. No significant difference in complications was noted between the two types of fixation systems. Forty-three percent of the patients underwent early bone grafting. Free muscle flaps were employed in 78% of patients with a 97% success rate. Local muscle flaps were utilized in 22% of patients with an 84% success rate. Local infection occurred in three patients (6%). Osteomyelitis occurred in two patients (4%). Bony union was present in 98% of patients (44 of 45). Limb salvage was 98% (44 of 45). Early bone grafting (< or = 3 months) yielded earlier bony union (average, 40 weeks) than late bone grafting (average, 52 weeks). This study proves the efficacy of an established protocol of early muscle flap coverage in the management of grade IIIB tibial fractures in a consecutive series of patients. Early bone grafting appears to be beneficial to early bony union. The intramedullary rod fixation system offers an acceptable alternative to the external fixator system in severe acute open tibial fractures.