We carried out a randomised, controlled trial in 157 patients who had isolated severe Gustilo type-IIIa and type-IIIb fractures of the metaphysis or diaphysis of the leg to determine the prevalence of vascular injuries and the role of vascular repair.
All patients had stable vital signs and clinically adequate circulation in their legs before operation.
In a control group of 64 patients we performed conventional surgery with systematic debridement and primary stabilisation of the fractures.
In the trial group of 93 patients the major vessels and nerves adjoining the compound fracture were routinely explored and repaired when necessary after the initial procedure.
Two of the 28 control patients (7.1%) with type-IIIb compound fractures had signs of inadequate circulation after the first operation.
Both had major vascular injuries which were demonstrated at a second procedure.
In the trial group, major vascular injuries were found in two of 54 patients (3.7%) with type-IIIa and 11 of 39 patients (28.2%) with type-IIIb compound fractures.
Compared with the control group the trial group showed improved results at both the immediate and long-term follow-up.
Routine exploration and early repair of injured major vessels of the leg in severe compound fractures gave encouraging results.
Mots-clés Pascal : Fracture ouverte, Jambe, Indice gravité, Epidémiologie, Prévalence, Association, Traumatisme, Vaisseau sanguin, Modalité traitement, Chirurgie, Homme, Pronostic, Os, Membre inférieur, Système ostéoarticulaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Artère pathologie, Veine pathologie, Chirurgie orthopédique
Mots-clés Pascal anglais : Open fracture, Leg, Severity score, Epidemiology, Prevalence, Association, Trauma, Blood vessel, Application method, Surgery, Human, Prognosis, Bone, Lower limb, Diseases of the osteoarticular system, Cardiovascular disease, Vascular disease, Arterial disease, Venous disease, Orthopedic surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0194357
Code Inist : 002B12B03. Création : 11/09/1998.