Abstract
Gustilo-Anderson type 3 open tibial fractures are commonly accompanied by extensive damage and serious complications, especially in types 3B and 3C.
A 25-year-old male was transferred after motor vehicle accident and the emergent choice was an above-knee amputation in other two hospital. A left open distal tibial fracture (Gustilo type 3C) with a wide and contaminated soft tissues defect, that extended from the knee to the midfoot, is accompanied by wasting of the anterior compartment muscles and ruptured of the anterior tibial artery. We did irrigation and debridement and then we placed an anteriomedial external fixation system type AO with pins. A cross-leg flap and free skin grafts from the opposite limb was performed three weeks after a daily irrigation and debridement, povidon and ozone cream bandages, and antibiotics. After twelve months of follow-up, the fracture was healed and the external fixator was removed.
Gustilo-Anderson type 3 open fractures remain a veritable orthopedic challenge, even for surgeons with greater experience, because of neurovascular damages, high amputation rate, and vast soft tissue injuries. The collaboration of the multidisciplinary surgical team led to preserve the limb with good result after one year. It is reasonable to judge and attempt a limb preservation even with wide open tibial fractures.
•Open tibial fracture (Gustilo type 3C) with an extended loss of muscles and soft tissue does not mean to amputate.•Delayed cross-leg flap and free skin grafts can be performed for open contaminated wound fractures.•Intraoperative and postoperative assessment of the injured artery by doppler will allow to preserve the limb circulation.