Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

Table 1 Summary of cases

	n (%)
Demographics
Mean age (43.1 yr)
Males	20 (27)
Females	54 (73)
Relevant comorbidities
Smoker	13 (18)
Diabetes mellitus	4 (6)
Alcohol excess	3 (4)
Dementia	1 (1)
Mechanism of injury
Road traffic accident	44 (59.5)
Fall from height	17 (23.0)
Cycling	4 (5.3)
Horse riding	2 (2.7)
Other	7 (9.5)
Injury
Associated polytrauma	25 (33)
Vascular injury	2 (3)
Fasciotomy	6 (8)
Treatment
TSF	61 (81)
IMN	9 (12)
IMN & Masquelet	5 (7)
Complications
Major
Deep infection	5 (7)
Re-fracture	2 (3)
Non-union	3 (4)
Minor
Pin-site infection	15 (25)
Equinus ankle stiffness	12 (16)
Mean follow-up (mo)
TSF	25
IMN	16

IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 2 Fracture classification and treatment

	IMN, n (%)	TSF, n (%)
OTA classification
41A3	0	3
42A1	4	0
42A2	5	0
42B3	0	8
42C2	3 (Masquelet)	11
42C3	2 (Masquelet)	25
43A1	0	4
43A2	0	8
43A3	0	2
Gustilo-Anderson classification
3A	10	16
3B	3	44
3C	1	1

OTA: Orthopaedic trauma association; IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 3 Time to union based on fixation method and fracture type

	Time to union (wk)
Fixation method
IMN	22
IMN/Masquelet	27.9
TSF	38.6
Gustilo-Anderson classification
3A (IMN)	25.9
3A (TSF)	41.1
3B (IMN)	42
3C (IMN)	68
3C (TSF)	44

IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 4 Summary of patients treated with Masquelet technique

Cases	Stage 1	Stage 2	Time to 2nd stage (wk)	Further procedures	Bone defect (cm)	Gustilo-Anderson classification
Patient 1	IMN & cement spacer	Spacer removal and bone graft	27	None	5	3A
Patient 2	IMN & cement spacer	Spacer removal and bone graft	23	None	3	3C
Patient 3	IMN & cement spacer	Spacer removal and bone graft	10	TSF (infection)	10	3B
Patient 4	IMN & cement spacer	TSF	9	None	6	3B
Patient 5	IMN & cement spacer	Exchange nailing, cement removal and bone graft	15	TSF (infection)	11	3B

IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 5 Treatment of infected cases

Cases	Organism	Treatment	Gustilo-Anderson classification
Patient 1 (M 62)	Staphylococcus, Clostridium	IMN converted to TSF after positive samples	3B
Patient 2 (F 72)	Staphylococcus	TSF	3B
Patient 3 (F 62)	Staphylococcus	TSF	3B
Patient 4 (F 22)	Staphylococcus	IMN (2nd stage Masquelet converted to TSF after positive microbiology samples)	3B
Patient 5 (M 32)	Staphylococcus	IMN (2nd stage Masquelet converted to TSF after positive microbiology samples)	3B

M: Male; F: Female; IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 6 Treatment of non-union following Taylor spatial frame application

Cases	Smoking status	Site of re-fracture	Treatment of non-union	Bone graft	Outcome
Patient 1 (M 31)	Smoker	Fracture	IMN	Yes	Bony union
Patient 2 (F 19)	Non-smoker	Fracture	Revision TSF (5 cm devitalised bone excised)	Yes	Bony union
Patient 3 (M 25)	Smoker	Fracture	IMN (fracture site opened)	Yes	Bony union

M: Male; F: Female; IMN: Intramedullary nail; TSF: Taylor spatial frame.

Table 7 Re-fracture following Taylor spatial frame removal

Cases	Time from frame removal (wk)	Site of re-fracture	Union prior to removal	Treatment of re-fracture	Infection
Patient 1 (M 49)	12	Docking site	Non-union	Revision TSF with bone graft	No
Patient 2 (M 62)	3	Docking site	CT-confirmed union	IMN with bone graft	Yes

M: Male; IMN: Intramedullary nail; TSF: Taylor spatial frame; CT: Computed tomography.