Open G3 lower limb fracture management in an Italian trauma center: comparison with international protocols

BACKGROUND: Since 1991, the British Orthopedic Association (BOA) and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) have been cooperating to spread orthoplasty practice all around the world creating a universally shared protocol. The aim of the study is to evaluate clinical and functional results of open Gustilo 3 (G3) fractures treated in an Italian trauma center, comparing management with orthoplasty protocol and recent literature. METHODS: All open G3 lower limbs fractures treated. from January 2011 to December 2016, in one Italian trauma center were recorded. The authors made a clinical and functional evaluation of patients first, based on primary and secondary indicators according to clinical relevance, and then a comparative analysis between two groups of patients (those subjected to definitive coverage by flaps and those subjected to treatment with negative pressure devices and denno-epidermal grafts). Finally, they compared patients' management to the international indications of BOA/BAPRAS guidelines. A total of 47 patients met the inclusion criteria, most male, young and active people, for a total of 49 limbs treated. G3B was the most frequent fracture. RESULTS: In the observational study. a long bone and skin healing time emerged. No significant difference between the two groups was observed with the comparative analysis. CONCLUSIONS: There is a general trend to postpone definitive treatment and coverage of lower limb fractures. The results show differences from those obtained using the British protocol and the main concepts of orthoplasty on the treatment of open fractures. The long healing time seems to be more typical of a classic old orthopedic approach rather than an orthoplastic one.