Early prophylactic bone grafting of high-energy tibial fractures.

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