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Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage.

Publication ,  Journal Article
DeBaun, MR; Goodnough, LH; Hidden, KA; Nork, SE; Kleweno, CP; Hebert-Davies, J
Published in: J Am Acad Orthop Surg
March 1, 2023

OBJECTIVE: The purpose of this study was to determine whether type III open high-energy tibia fractures treated with immediate intramedullary nailing (IMN) and primary closure yield low rates of flap coverage. METHODS: Patients with high-energy type IIIA open tibia (OTA/AO42/43) fractures treated with IMN over a 10-year period at a level 1 academic center with at least 90 days of in-person postoperative follow-up were included. Single-stage reamed IMN with acute primary skin closure using Allgower-Donati suture technique was utilized in patients without notable skin loss. The primary outcome was treatment failure of acute primary skin closure requiring subsequent soft-tissue coverage procedures. RESULTS: A total of 111 patients with type IIIA tibia fractures met inclusion criteria. Of 107 of the 111 patients (96%) with skin closure at the index surgery, 95 of the 107 patients (89%) healed their soft-tissue envelop uneventfully. Among the patients who failed primary closure (11%), five required free tissue transfers, five required local rotational flaps, and two underwent split thickness skin grafting only. Patients who failed acute primary closure declared within an average of 8 weeks postoperatively. DISCUSSION: Treatment of type IIIA open high-energy tibia fractures with immediate IMN and primary closure using meticulous soft-tissue handling yields low rates of flap coverage.

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Published In

J Am Acad Orthop Surg

DOI

EISSN

1940-5480

Publication Date

March 1, 2023

Volume

31

Issue

5

Start / End Page

252 / 257

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tibial Fractures
  • Tibia
  • Surgical Flaps
  • Skin
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Fractures, Open
  • Fracture Healing
 

Citation

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Chicago
ICMJE
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DeBaun, M. R., Goodnough, L. H., Hidden, K. A., Nork, S. E., Kleweno, C. P., & Hebert-Davies, J. (2023). Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage. J Am Acad Orthop Surg, 31(5), 252–257. https://doi.org/10.5435/JAAOS-D-22-00469
DeBaun, Malcolm R., L Henry Goodnough, Krystin A. Hidden, Sean E. Nork, Conor P. Kleweno, and Jonah Hebert-Davies. “Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage.J Am Acad Orthop Surg 31, no. 5 (March 1, 2023): 252–57. https://doi.org/10.5435/JAAOS-D-22-00469.
DeBaun MR, Goodnough LH, Hidden KA, Nork SE, Kleweno CP, Hebert-Davies J. Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage. J Am Acad Orthop Surg. 2023 Mar 1;31(5):252–7.
DeBaun, Malcolm R., et al. “Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage.J Am Acad Orthop Surg, vol. 31, no. 5, Mar. 2023, pp. 252–57. Pubmed, doi:10.5435/JAAOS-D-22-00469.
DeBaun MR, Goodnough LH, Hidden KA, Nork SE, Kleweno CP, Hebert-Davies J. Type III Open Tibia Fractures Treated With Single-Stage Immediate Medullary Nailing and Attempted Primary Closure Yield Low Rates of Flap Coverage. J Am Acad Orthop Surg. 2023 Mar 1;31(5):252–257.

Published In

J Am Acad Orthop Surg

DOI

EISSN

1940-5480

Publication Date

March 1, 2023

Volume

31

Issue

5

Start / End Page

252 / 257

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tibial Fractures
  • Tibia
  • Surgical Flaps
  • Skin
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Fractures, Open
  • Fracture Healing