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.