External fixation associated with limited internal fixation and vacuum sealing drainage repair Gustilo II and III fracture：time effectiveness and staging

Cheng Yong-tao; Wang Wei; Zhao Yan; Zhang Hai-yang; Zhang Shu-cai

doi:10.3969/j.issn.2095-4344

Abstract：BACKGROUND:Due to specificity of injury and site, surgical treatment for open fractures is complex and difficult, especialy for those patients with high Gustilo grading and severe damage. At the same time, joint fracture requires high reduction technique and may induce high infection rate or complications, even high amputation rate. The fracture and surrounding tissue cannot be restored through one surgery. <br> OBJECTIVE:To explore the clinical effects of external fixation associated with limited internal fixation and vacuum-sealing drainage on Gustilo II and III open fractures. <br> METHODS:From January 2012 to December 2013, 13 cases of Gustilo II and III fractures were treated by external fixation combined with limited internal fixation and vacuum-sealing drainage. There were 11 male and 2 female. Three cases were Gustilo II fracture and 10 cases were Gustilo III fractures. According to the principle of timeliness, patients received the first or effective emergency debridement. Al the fractures were fixed by external fixator combined with limited internal fixation. The wounds were sealed with vacuum-sealing drainage. Phased restoration of soft tissue injury and fracture treatment were performed. <br> RESULTS AND CONCLUSION:The involved 13 patients were folowed up for 6-18 months, and 12 cases were healed by split-thickness skin graft or flap transposition at the second phase. The wound healing time was 12-18 days, with an average of 14 days. Wound infection occurred in 1 case and was finaly repaired by split-thickness skin graft folowing debridement and vacuum-sealing drainage. Pin tract infection occurred in 4 cases and was controled by dressing. Schanz screw loose occurred in 5 cases at 4 months postoperatively. Al the 13 cases had obtained bone union and the healing time was 4-12 months. Gustilo II and III open fractures can be treated by timeliness and staging method, which is conductive to properly assess articular fractures and soft tissue injury. External fixator combined with limited internal fixation and vacuum-sealing drainage by phased application can not only protect soft tissue and accelerate tissue repair, but also reduce infection and complications, lower the amputation rate, and shorten treatment time. So it is an effective treatment for Gustilo II and III fractures.