Treatment of open fractures of the leg

Results of treatment of 112 patients were analyzed. All patients were treated at the Moscow Clinical Hospital named after N.I. Pirogov during the period from 1998 to 2002. Fifty-four patients had I and II type,38 — IIIA,14 — IIIB and 6 patients — IIIC type of fractures by Gustilo classification. Tactics of treatment was defined by patient’s general condition and the degree of soft tissue injury. In fractures of I and II type primary UTN osteosynthesis was preferable; in fractures of IIIA type primary osteosynthesis with AO rod device or Piless device followed by final UTN osteosynthesis were performed. In fractures of IIIB type osteosynthesis was carried out using device. To all patients with fractures of IIIC type the limb amputation was performed. Healing by first intention took place in fractures of I and II type. In fractures of IIIA and IIIB type the open management of wound with following closure during sequential debridement was preferred. When tibia necrosis developed, the resection in fractures zone with following early defect substitution by Ilizarov technique was carried out.