Lower extremity soft tissue reconstruction and amputation rates in patients with open tibial fractures in Sweden during 1998–2010

BMC Surgery

Karl-Åke Jansson¹  Zewar Al Dabbagh¹  Pehr Sommar²  Birgit Stark²  Rüdiger J Weiss¹  Ulrika Tampe¹ 

[1] Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet at Karolinska University Hospital, SE-17176 Stockholm, Sweden;Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

关键词: Soft tissue injury;    Limb salvage;    Lower extremity reconstruction;    Amputation;    Open fracture;    Tibial shaft fracture;    Skeletal trauma;   

Others  :  1091665
DOI  :  10.1186/1471-2482-14-80

 received in 2014-04-13, accepted in 2014-10-08,  发布年份 2014

【 摘 要 】

Background

The rates of soft tissue reconstruction and amputation after open tibial fractures have not been studied on a national perspective. We aimed to determine the frequency of soft tissue coverage after open tibial fracture as well as primary and secondary amputation rates.

Methods

Data on all patients (> = 15 years) admitted to hospital with open tibial fractures were extracted from the Swedish National Patient Register (1998–2010). All surgical procedures, re-admissions, and mechanisms of injury were analysed accordingly. The risk of amputation was calculated using logistic regression (adjusted for age, sex, mechanism of injury, reconstructive surgery and fixation method). The mean follow-up time was 6 (SD 3.8) years.

Results

Of 3,777 patients, 342 patients underwent soft tissue reconstructive surgery. In total, there were 125 amputations. Among patients with no reconstructive surgery, 2% (n = 68 patients) underwent amputation. In an adjusted analysis, patients older than 70 years (OR = 2.7, 95%, CI = 1.1-6) and those who underwent reconstructive surgery (OR = 3.1, 95% CI = 1.6-5.8) showed higher risk for amputation. Fixations other than intramedullary nailing (plate, external fixation, closed reduction and combination) as the only method were associated with a significant higher risk for amputation (OR 5.1-14.4). Reconstruction within 72 hours (3 days) showed better results than reconstruction between 4–90 days (p = 0.04).

Conclusions

The rate of amputations after open tibial fractures is low (3.6%). There is a higher risk for amputations with age above 70 (in contrast: male sex and tissue reconstruction are rather indicators for more severe soft tissue injuries). Only a small proportion of open tibial fractures need soft tissue reconstructive surgery. Reconstruction with free or pedicled flap should be performed within 72 hours whenever possible.

【 授权许可】

   
2014 Tampe et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

Figure 2.

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