Treatment of grade 3B open tibia fracture by segmental resection and bone transport: A case report and literature review

Abstract

Introduction and importance

Open tibial fractures represent the most prevalent type of open long bone fracture, constituting 13.7 % of all open fractures, typically resulting from road traffic accidents and falls from a standing position. The AO Trauma Foundation has developed comprehensive treatment procedures that encompass wound irrigation and debridement, fracture stabilization, and either delayed primary wound closure or early flap coverage. Managing Gustilo IIIB tibial fractures in adults poses problems due to elevated complication rates, increased infection risk, and prolonged union times. Consequently, multi-surgical intervention is necessary for the management of Gustilo Type IIIB open tibial fractures. Additional research on a related topic are compared to furnish a thorough summary of the existing knowledge concerning the effective care of Gustilo Type IIIB open tibial fractures accompanied by significant muscle rupture. Our objective is to assess the surgical efficacy of bone transport (Ilizarov and External LCP Technique) combined with segmental resection for the treatment of Grade IIIB open tibial fractures.

Case presentation

A case study of a patient with a Gustilo Type IIIB tibial fracture featuring a 7 cm bone defect, managed through segmental resection and bone transport utilizing the Ilizarov technique. We assessed the patient periodically following each surgical procedure. We transition from Ilizarov to an external Locking Compression Plate (LCP) till the ultimate consolidation of distraction osteogenesis. The outcomes were assessed clinically and radiologically to evaluate the patient's leg function, infection status, and bone union.

Clinical discussion

Open tibial fractures accompanied by bone and soft tissue defects pose significant challenges for achieving both fracture union and wound healing. External fixation is a commonly employed technique for the management of exposed tibial fractures. To address the deficiency, we performed segmental excision and bone translocation with the Ilizarov technique and external LCP. LCP serves as a less cumbersome and more tolerable external fixator compared to other external fixators. The sole worry surrounding the LCP external fixator was its sufficient stability for early weight-bearing.

Conclusion

The Ilizarov method efficiently treats complicated fractures with significant bone and soft tissue abnormalities. Subsequently, we can employ external LCP to facilitate bone regeneration before doing bone grafting and internal fixation. Consequently enhancing patient comfort during routine activities.