Caudle R J, Stern P J
J Bone Joint Surg Am. 1987 Jul;69(6):801-7.
Sixty-two Type-III open fractures of the tibial shaft are reported on. Eleven were Type IIIA, and three of them had non-union while none were associated with deep infection or required secondary amputation. Forty-two were Type IIIB, and fifteen of them had non-union, twelve were associated with deep infection, and seven required secondary amputation. However, in the twenty-four Type-IIIB fractures that were treated with early restoration of the damaged soft tissue by local flaps or free tissue transfer, the rate of complications was significantly reduced to five non-unions, two deep infections, and two secondary amputations. Unfortunately, of the nine Type-IIIC injuries, seven ultimately required secondary amputation, from two days to sixty-three months after the initial injury, because of pain, sepsis, non-union, or failure of the vascular repair. Only two patients who had a Type-IIIC fracture have avoided amputation to date, and their results were poor.
报告了62例胫骨干Ⅲ型开放性骨折。其中11例为ⅢA型，3例发生骨不连，无一例发生深部感染或需要二期截肢。42例为ⅢB型，其中15例发生骨不连，12例发生深部感染，7例需要二期截肢。然而，在24例通过局部皮瓣或游离组织移植早期修复受损软组织的ⅢB型骨折中，并发症发生率显著降低至5例骨不连、2例深部感染和2例二期截肢。不幸的是，在9例ⅢC型损伤中，7例最终因疼痛、败血症、骨不连或血管修复失败而在初次受伤后2天至63个月需要二期截肢。迄今为止，只有2例ⅢC型骨折患者避免了截肢，但其结果不佳。
