Open type IIIB and IIIC fractures treated by an orthopaedic microsurgical team.

An orthopaedic team with an extensive microsurgical background treated 46 patients with open fractures, 22 Type IIIB and 24 IIIC, of the upper and lower extremities during the past 10 years. All 24 patients with Type IIIC fractures and 12 with IIIB fractures had associated arterial injuries. In all patients from both categories, an effort was made to revascularize the limbs using microsurgical techniques and to stabilize the fractures as early as possible. Of the Type IIIC fractures, 16 were in the lower extremity and 8 in the upper extremity. Of the Type IIIB injuries, 8 were in the lower and 14 in the upper extremity. Of the limbs with Type IIIC fractures, 13 (54.2%) were salvaged and 11 (45.8%) were amputated. The latter was related to the proportionally high number of tibial fractures (13 of 24), 8 of which were amputated. None of the patients with Type IIIB injuries underwent amputation. These results suggest that limb salvage in Type IIIB and, particularly, Type IIIC injuries was associated with the application of microsurgical techniques to restore complete (Type IIIC) and incomplete (Type IIIB) ischemia. The number of amputations in Type IIIC fractures was attributed to the open tibial injuries, which are reported to have an amputation rate ranging from 60% to 100%.