Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

Jaña Neto, Frederico Carlos; Canal, Marina de Paula; Alves, Bernardo Aurélio Fonseca; Ferreira, Pablício Martins; Ayres, Jefferson Castro; Alves, Robson

doi:10.1016/j.rboe.2016.01.002

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Original Article • Rev. bras. ortop. 51 (2) • Mar-Apr 2016 • https://doi.org/10.1016/j.rboe.2016.01.002 copy

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III^☆ ☆ Work performed in the Complexo Hospitalar do Mandaqui, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014.

METHODS:

This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate.

RESULTS:

116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group.

CONCLUSION:

The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

Tibial fractures; Amputation/epidemiology; Amputation/methods

Characteristics	n (%)	95% CI
Gender
Male	99 (85%)^a	77.68% to 90.74%^a
Female	17 (15%)	9.26% to 22.32%

Side affected
Right	51 (44%)	35.27% to 53.05%
Left	65 (56%)	46.95% to 64.73%

Location of the fracture
Diaphyseal fracture of the tibia	78 (67%)^a	58.25% to 75.13%^a
Fracture of the tibial plateau	13 (11%)	6.54% to 18.36%
Fracture-dislocation of the ankle	10 (9%)	4.59% to 15.31%
Tibial pilon fracture	5 (4%)	1.60% to 9.95%
Ankle fracture	5 (4%)	1.60% to 9.95%
Distal fracture of the tibia (extra-articular)	3 (3%)	0.5% to 7.66%
Proximal fracture of the tibia (extra-articular)	2 (2%)	0% to 6.46%

Trauma mechanism
Motorcycle accident	66 (57%)^a	47.80% to 65.55%^a
Being run over by a car	20 (17%)	11.37% to 25.21%
Falling from a height	8 (7%)	3.34% to 13.21%
Being run over by a motorcycle	4 (3%)	1.06% to 8.82%
Gunshot wound	4 (3%)	1.06% to 8.82%
Occupational accident	4 (3%)	1.06% to 8.82%
Bicycle accident	4 (3%)	1.06% to 8.82%
Fall	3 (3%)	0.5% to 7.66%
Car accident	2 (2%)	0% to 6.46%
Stab wound	1 (1%)	0% to 5.20%
Total	116 (100%)

Age/Gender	Trauma mechanism	AO fracture type/classification	Gustilo	Tscherne	MESS	Initial treatment	Mortality	Infection
32/M	Motorcycle accident	Tibial plateau (41-C3)	IIIC	III	10	Linear external fixation	–	–
21/M	Gunshot wound	Tibial plateau (41-B1)	IIIC	III	10	Transarticular external fixation, anastomosis of popliteal artery and fasciotomy	–	–
54/M	Motorcycle accident	Tibial plateau (41-C1)	IIIB	III	10	Transarticular external fixation	–	–
39/M	Motorcycle accident	Extra-articular distal tibia (43-A3)	IIIC	III	10	Linear external fixation and fasciotomy	–	–
47/M	Run over by car	Tibial diaphysis (42-C2)	IIIC	III	10	Surgical cleaning and splint	Yes	–
84/F	Run over by motorcycle	Tibial diaphysis (42-C2)	IIIC	III	11	Linear external fixation and fasciotomy	–	Yes
42/M	Motorcycle accident	Extra-articular distal tibia (43-A3)	IIIB	III	5	Linear external fixation	–	Yes

	Amputation % (95% CI)	Salvaged limb % (95% CI)	Total % (95% CI)
Male (%)	88% (51% to 99%)^a	85% (77% to 91%)^a	85% (78% to 91%)^a
Gustilo and Anderson (%)
IIIA	0% (0% to 37%)	87% (79% to 92%)^a	81% (73% to 87%)^a
IIIB	25% (6% to 60%)	11% (6% to 19%)	12% (7% to 19%)
IIIC	75% (40% to 94%)	2% (0% to 7%)	7% (3% to 13%)

Tscherne classification (%)
I	0% (0% to 37%)	2% (0% to 8%)	3% (1% to 8%)
II	0% (0% to 37%)	80% (71% to 86%)^a	74% (65% to 81%)^a
III	100% (63% to 100%)^a	18% (11% to 26%)	23% (16% to 32%)

MESS (%)
<7	12% (0% to 49%)	95% (89% to 98%)^a	90% (83% to 94%)^a
≥7	88% (51% to 99%)^a	5% (2% to 11%)	10% (6% to 17%)
Multiple trauma (%)	50% (22% to 78%)	9% (4% to 15%)	11% (6% to 18%)
Associated fractures (%)	50% (22% to 78%)	19% (13% to 28%)	22% (15% to 30%)
Compartment syndrome (%)	38% (13% to 70%)	6% (3% to 13%)	9% (5% to 15%)
Infection (%)	62% (30% to 87%)	17% (11% to 25%)	20% (13% to 28%)
Mortality (%)	12% (0% to 49%)	1% (0% to 6%)	2% (0% to 6%)
Total (n)	8	108	116

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: fredericojana@mac.com (F.C. Janã Neto).

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Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III☆ ☆ Work performed in the Complexo Hospitalar do Mandaqui, São Paulo, SP, Brazil.

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III^☆ ☆ Work performed in the Complexo Hospitalar do Mandaqui, São Paulo, SP, Brazil.