Abstract
Background
To improve patient pathways we have, in selected patients, begun to acutely apply circular (rather than temporary monolateral) fixators with simultaneous or subsequent soft tissue closure. We present early results.
Methods
Adult patients treated using an Ilizarov frame prior to soft tissue management were identified from our Ilizarov database. This data was supplemented by medical record review.
Results
26 cases were identified (22 open fractures (11 IIIA, 11 IIIB), 1 compartment syndrome and 3 infected salvage). All IIIA injuries were closed acutely alongside frame application. In IIIB fractures, 3 were closed following acute shortening, 1 required a local flap and 7 free tissue transfer. Soft tissue reconstruction was simultaneous to frame application in 5 patients, the remainder within 72 hours. In salvage cases, 2 required free and one a local muscle flap, all after frame application. There were no soft tissue cover failures. One patient underwent evacuation of a flap haematoma, there were no other unexpected returns to theatre for soft tissue problems. No patients required adjustment of frame components to allow soft tissue access.
Conclusion
This approach appears to simplify treatment, reducing length of stay. We are collecting a matched patient series treated by traditional pathways for comparison.
