Abstract
Introduction
The results of a prospective study of primary bone grafting in a selective group of patients with High energy open fractures (Grade III) of limbs with communition or bone loss are presented.
Materials and methods
Out of 310 Gustilo Grade III Open injuries managed over a 4 year period, 42 patients with Grade III injuries underwent bonegrafting after satisfying the inclusion criteria (Age <60, Debridement within 12hrs, Stable fracture fixation, wound cover within 72hrs) at or before the time of wound closure or soft tissue cover. Patients with Grade IIIc fractures, farmyard injuries, needing freeflaps, ASA grade of 3 or more, injury severity score > 25 or monomelic polytrauma were excluded. The bone involved was femur in 26 patients, tibia in 4, forearm in 9 and humerus in 3 patients. The injury was Grade IIIA in 11 and Grade IIIB in 31 patients. Wounds were primarily closed immediately after debridement in 28 (66.7%) patients, by split thickness skingrafting in 7 (16.7%) and by suitable regional flaps in 7 (16.7%) patients. Rigid fixation was achieved in all patients with variety of implants depending on the fracture personality. Autologous Cortico-cancellous bonegrafting was done immediately after debridement in 33 (78.6%) and within 72hrs at the time of soft tissue cover in 9 (21.4%) patients.
Results
At a mean follow-up of 2.4 (1-4) yrs all fractures had united except one which ended in infected nonunion (2.4%). Deep Infection was present in 4 (9.5%) patients. The mean time for Union was 15 (10-32) wks for Grade IIIA and 16.6 (12-32) wks for Grade IIIB fractures. No complications specific to bonegrafting were noted. Secondary procedures were needed in 4 (9.5%) patients to achieve union.
Conclusion
Primary bonegrafting was possible in 13.5% of the total patients with Grade III open fractures managed and it is a safe procedure that can hasten bone healing and reduce the union time without increased risk of complications. A team approach (Ortho+Plastic) from day one of management with careful patient selection is the key.
