Early prophylactic bone grafting of high-energy tibial fractures

S. S. Blick, R. J. Brumback, R. Lakatos, A. Poka, A. R. Burgess

Research output: Contribution to journalArticle

Abstract

Fifty-three high-energy tibial fractures treated with early prophylactic posterolateral bone grafting were retrospectively reviewed. The bone-grafting procedures were performed at a mean of ten weeks following injury and at a mean of eight weeks following soft-tissue coverage. Ninety-six percent of the fractures had associated injuries with a mean injury severity score of 20.9. Seventy-nine percent of the fractures were classified as Grade III open fractures, and 40% had bone loss greater than 50% of the cortical circumference. Ninety-six percent of the fractures healed at a mean time of 43 weeks after injury. Segmental bone loss and soft-tissue injury requiring flap coverage were the best predictors of prolonged time to union. Comparison with a matched historical control group of tibial fractures not receiving early bone grafts revealed a mean reduction in time to union of 11.7 weeks (p = 0.03). The incidence of chronic osteomyelitis was 1.9%. These results are attributed to early and repeated aggressive debridement, immediate rigid external fixation, early soft-tissue coverage, and early posterolateral bone grafting. Recommendations include posterolateral concellous bone grafting two weeks following wound closure by delayed primary closure, split-thickness skin graft, or local rotational myoplasty. A six-week delay following freely vascularized soft-tissue coverage prior to bone grafting is suggested.

Original languageEnglish (US)
Pages (from-to)21-41
Number of pages21
JournalClinical Orthopaedics and Related Research
Issue number240
StatePublished - 1989
Externally publishedYes

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Tibial Fractures
Bone Transplantation
Wounds and Injuries
Bone and Bones
Transplants
Soft Tissue Injuries
Open Fractures
Injury Severity Score
Debridement
Osteomyelitis
Control Groups
Skin
Incidence

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Blick, S. S., Brumback, R. J., Lakatos, R., Poka, A., & Burgess, A. R. (1989). Early prophylactic bone grafting of high-energy tibial fractures. Clinical Orthopaedics and Related Research, (240), 21-41.

Early prophylactic bone grafting of high-energy tibial fractures. / Blick, S. S.; Brumback, R. J.; Lakatos, R.; Poka, A.; Burgess, A. R.

In: Clinical Orthopaedics and Related Research, No. 240, 1989, p. 21-41.

Research output: Contribution to journalArticle

Blick, SS, Brumback, RJ, Lakatos, R, Poka, A & Burgess, AR 1989, 'Early prophylactic bone grafting of high-energy tibial fractures', Clinical Orthopaedics and Related Research, no. 240, pp. 21-41.
Blick SS, Brumback RJ, Lakatos R, Poka A, Burgess AR. Early prophylactic bone grafting of high-energy tibial fractures. Clinical Orthopaedics and Related Research. 1989;(240):21-41.
Blick, S. S. ; Brumback, R. J. ; Lakatos, R. ; Poka, A. ; Burgess, A. R. / Early prophylactic bone grafting of high-energy tibial fractures. In: Clinical Orthopaedics and Related Research. 1989 ; No. 240. pp. 21-41.
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