Mid to Long-term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed with a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Centre.

The aim of this study was to report experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open tibial fractures. Design: A prospectively maintained database was retrospectively interrogated. Single major trauma centre in the United Kingdom. All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study centre. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another centre, had pre-existing infection, sustained a periarticular fracture or those who did not afford a minimum of 12-months follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. 225 patients met inclusion criteria. Mean age was 43.2 years old, with 72% males, 34% smokers and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). 8 (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. 79 (35.1%) patients had a secondary intervention of which; 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. Orthoplastic care including circular frame fixation for GA-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.