Ganga Medical Centre & Hospitals Pvt Ltd

Coimbatore, India.


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You are in - Home >> Plastic, Hand and Reconstructive Microsurgery and Burns >> Lower Limb Reconstruction >> Open Tibial Fractures

Open Tibial Fractures

What is an open tibial fracture?

Any fracture with the bone exposed through a break in the skin is an open fracture. The leg bone, called the tibia, is especially prone to such injuries as it lies close to the skin.

What are the problems associated with such an injury?

Two major problems are seen in open fractures: non-union and osteomyelitis. Healing of such fractures is impaired and they typically take longer to unite or may not unite at all. Since the bone gets exposed to the environment, chances of it getting infected are very real; such an infection is termed osteomyelitis.

How are they treated?

To ensure healing without infection, the wounds need to be surgically cleaned immediately, under proper anaesthesia. The bone ends are placed in correct position and fixed with rods and pins outside the body. Once infection has been ruled out, fractures are fixed with implants inside the body, e.g. plates and screws.

What is the role of Plastic Surgery here?

After proper fixing of these fractures, the bone needs to be covered with tissue to ensure union. The faster this is done, the better the blood flow to the healing fracture. Plastic Surgery helps in providing this vital cover by transferring skin, soft tissue or muscles over the fracture, as necessary.

What is a microsurgical free flap?

Sometimes the injury to the leg is quite severe and large wounds may be present. In such a situation, saving the limb from amputation requires transferring a large amount of tissue (usually from the thigh) along with its own blood supply. These blood vessels then have to be joined to the injured leg under a microscope. This is a complex procedure requiring special skills and techniques of Microsurgery and is called a ‘free flap’.

What is the length of hospital stay after an open tibial fracture?

Most patients end up requiring 2-3 procedures and about 10 days of hospital stay. Assisted walking is commonly allowed by 3 weeks, though it may take a few months for full healing depending on the severity of the injury.

What can be done for older injuries or after initial treatment elsewhere?

We regularly receive patients a few days to weeks or even months after such injuries. Many of them have wounds that have not healed in spite of medical attention. Plastic surgery is then often necessary to let these wounds heal. These cases also tend to be more complex and our immense experience in dealing with such assures best possible function.

Severe injury with complex fractures in the leg and thigh. A muscle from the leg has been shifted to cover the wound, called a gastrocnemius myocutaneous flap

Pre operative wound

Xray showing severe bony injury

Intra operative picture, with muscle flap ready for inset

After wound healing