Clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures

Lin Fang; Kang Yongqiang; Rui Yongjun; Liu Jun; Wang Yapeng; Wu Yongwei; Ma Yunhong; Wang Peng; Shan Xiaotian

doi:10.3760/cma.j.cn501225-20260108-00016

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > > Accepted Manuscript

Lin Fang,Kang Yongqiang,Rui Yongjun,et al.Clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures[J].Chin J Burns Wounds,2026,42(5):1-8.DOI: 10.3760/cma.j.cn501225-20260108-00016.

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Clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures

doi: 10.3760/cma.j.cn501225-20260108-00016

Department of Trauma Orthopedics, Wuxi Ninth People's Hospital, Wuxi 214000, China

Funds:

Wuxi Top Medical Expert Team of "Taihu Talent Program" WXTTP-2020-06

Wuxi Municipal Health Commission Major Project Z202401

Wuxi "Double Hundred" Award for Outstanding Young and Middle‐aged Medical Talents HB2023126

More Information

Corresponding author: Rui Yongjun, Email: ruiyongjun@suda.edu.cn
Received Date: 2026-01-08
Available Online: 2026-04-30

Abstract

Abstract

Objective To investigate the clinical efficacy of orthoplastic management for Gustilo type ⅢB open ankle fractures. Methods This study was a retrospective case series study. From January 2018 to August 2024, 33 patients with Gustilo type IIIB open ankle fractures who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 25 males and 8 females, aged 25-65 (44±12) years. The area of skin and soft tissue defects ranged from 6 cm × 3 cm to 27 cm × 14 cm. The length of bone defect ranged from 3.0 to 9.2 cm (mean 3.7 cm). All patients were treated with a standardized orthoplastic management. Phase 1 (Stage 1): emergency radical debridement was performed, antibiotic-loaded bone cement was placed in the tibial defect, temporary stabilization was achieved with an external fixator or an antibiotic cement-coated plate, nerves and tendons were repaired, and the remaining wound was covered with vacuum-assisted closure. Phase 1 (Stage 2): within 3 to 7 days, repeat debridement and bone cement exchange were performed, definitive internal fixation was either applied or retained, and soft tissue reconstruction was completed with a free anterolateral thigh (ALT) flap. Phase 2 (Stage 3): at 7 to 30 weeks post-injury (mean 15.8 weeks), the bone cement spacer was removed, the defect volume was measured, and precise iliac crest bone graft mixed with vancomycin was implanted; the induced membrane and soft tissues were then sutured. Postoperative flap survival and infection-related complications at different stages were recorded. During follow-up, flap appearance and texture, scar condition at the donor and recipient sites, and bone healing were documented. At the last follow-up, the score of the affected foot was evaluated using the foot and ankle function assessment scale, and the recovery of activities of daily living was calculated. The Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were assessed using the 36-Item Short Form Health Survey (SF-36) to reflect patient health outcomes. Results Complete flap survival was achieved in 30 patients. Partial flap necrosis occurred in 3 patients, among whom 1 case healed by direct suture after debridement, and 2 cases healed by skin grafting after debridement. Infection-related complications occurred in 4 patients, including superficial infection in 3 cases (1 after stage I second phase, 2 after stage II third phase), all of which were controlled after debridement with wound healing. Bone infection occurred in 1 case (after stage I second phase), which was controlled after repeated thorough debridement and antibiotic-loaded bone cement packing, and bone grafting healed. The follow-up period ranged from 12 to 57 months (mean 26.7 months). All flaps showed good color and texture. Scar hyperplasia at the flap donor site occurred in 3 cases, while only linear scars remained at the recipient site. At final follow-up, the FAAM score score of the affected foot was (71±4) points, and the recovery of activities of daily living reached (85±5)%. The PCS score on the SF-36 was (78±4) points, and the MCS score was (70±11) points. Conclusions The orthoplastic management for Gustilo type ⅢB open ankle fractures resulted in low infection and complication rates, along with satisfactory functional recovery of the ankle joint.
- Fractures, open,
- Ankle joint,
- Tibia,
- Surgical flaps,
- Fracture fixation,
- Orthoplastic management,
- Wound repair

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References(40)

References

[1]	WangZ, TangX, LiS, et al. Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the "Logsplitter" injury[J]. J Orthop Surg Res, 2017,12(1):3. DOI: 10.1186/s13018-016-0502-y.
[2]	李海, 邓呈亮, 肖顺娥, 等. 旋股外侧动脉嵌合穿支皮瓣修复足踝部复合组织缺损的效果[J].中华烧伤与创面修复杂志,2025,41(4):370-377. DOI: 10.3760/cma.j.cn501225-20240202-00045.
[3]	XuY, FanX, HeX, et al. Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases[J]. BMC Musculoskelet Disord, 2021,22(1):34. DOI: 10.1186/s12891-020-03894-y.
[4]	MococainP, Bejarano-PinedaL, GlissonR, et al. Biomechanical effect on joint stability of including deltoid ligament repair in an ankle fracture soft tissue injury model with deltoid and syndesmotic disruption[J]. Foot Ankle Int, 2020, 41(9): 1158-1164. DOI: 10.1177/1071100720929007.
[5]	计鹏, 曹涛, 张智, 等. 股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果[J].中华烧伤与创面修复杂志,2023,39(10):926-932. DOI: 10.3760/cma.j.cn501225-20230627-00232.
[6]	芮永军, 吴永伟, 刘军, 等. 游离皮瓣修复Gustilo ⅢB、ⅢC型胫腓骨骨折伴软组织缺损的临床疗效[J].中华创伤杂志,2018,34(10):881-885. DOI: 10.3760/cma.j.issn.1001-8050.2018.10.005.
[7]	WordsworthM, LawtonG, NathwaniD, et al. Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of major trauma networks and national guidelines[J]. Bone Jt J, 2016, 98-B(3): 420-424. DOI: 10.1302/0301-620X.98B3.35818.
[8]	唐举玉, 卿黎明, 吴攀峰, 等. 改良腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损[J].中华显微外科杂志,2015,38(04):338-341. DOI: 10.3760/cma.j.issn.1001-2036.2015.04.008.
[9]	仲海燕, 陈勇, 杜轩宇, 等. 足踝部高压电烧伤创面修复的带蒂轴型皮瓣选择策略[J].中华烧伤与创面修复杂志,2023,39(10):939-946. DOI: 10.3760/cma.j.cn501225-20230613-00212.
[10]	MundiR, ChaudhryH, NiroopanG, et al. Open tibial fractures: updated guidelines for management[J]. JBJS Rev, 2015, 3(2): e1. DOI: 10.2106/JBJS.RVW.N.00051.
[11]	唐崧杰, 崔红旺, 王挺锐. 外固定支架联合负载抗生素硫酸钙对胫腓骨开放性骨折患者术后感染及骨愈合的影响[J]. 解放军医学杂志, 2023, 48(9): 1034-1039. DOI: 10.11855/j.issn.0577-7402.1404.2023.0213.
[12]	KrijghDD, TeunisT, ListEB, et al. Mental health is strongly associated with capability after lower extremity injury treated with free flap limb salvage or amputation[J]. Eur J Trauma Emerg Surg, 2024,50(3):755-762. DOI: 10.1007/s00068-024-02459-1.
[13]	刘文剑, 张红艳, 刘德伍. 不同类型的组织瓣修复胫骨近端骨折术后钢板外露伴感染创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(12):1140-1148. DOI: 10.3760/cma.j.cn501225-20231101-00171.
[14]	杨亮, 周荣, 巨积辉, 等. 游离双侧股前外侧内增压型串联皮瓣修复足踝部大面积创面的临床疗效[J].中华烧伤与创面修复杂志,2025,41(1):61-69. DOI: 10.3760/cma.j.cn501225-20240508-00164.
[15]	胡大海, 张月. 毁损性创面修复重建技术及策略探索[J].中华烧伤与创面修复杂志,2024,40(9):812-817. DOI: 10.3760/cma.j.cn501225-20240807-00296.
[16]	胡大海, 李梦洋, 王鹏. 复杂创面修复前沿进展:从微环境调控到精准医疗实践[J].中华烧伤与创面修复杂志,2025,41(5):417-425. DOI: 10.3760/cma.j.cn501225-20250407-00171.
[17]	王绍钱, 王徽, 贾其余. 膜诱导技术联合游离超薄股前外侧穿支皮瓣修复足踝部创面的临床疗效分析[J]. 解放军医学杂志, 2025, 50(11): 1407-1413. DOI: 10.11855/j.issn.0577-7402.1121.2025.0716.
[18]	ChummunS, WrightTC, ChapmanTWL, et al. Outcome of the management of open ankle fractures in an ortho-plastic specialist centre[J]. Injury, 2015,46(6):1112-1115. DOI: 10.1016/j.injury.2014.12.017.
[19]	CortezA, UrvaM, HaongaB, et al. Outcomes of intramedullary nailing and external fixation of open tibial fractures: three to five-year follow-up of a randomized clinical trial[J]. J Bone Joint Surg Am, 2022,104(21):1877-1885. DOI: 10.2106/JBJS.22.00016.
[20]	陈桂全, 陈伟明, 梁嘉均, 等. 皮瓣移植联合VSD技术修复下肢骨折内固定术后钢板外露创面[J].中华显微外科杂志,2021,44(2):175-177. DOI: 10.3760/cma.j.cn441206-20201225-00421.
[21]	MyattA, SaleebH, RobertsonGAJ, et al. Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review[J]. Br Med Bull, 2021,139(1):48-58. DOI: 10.1093/bmb/ldab013.
[22]	WangY, ZhouM, WangP, et al. Orthoplastic management of Gustilo-Anderson type IIIB/C open tibial fractures: a consecutive 10-year series from China Level I trauma center[J]. Int J Surg, 2025,111(9):6135-6150. DOI: 10.1097/JS9.0000000000002809.
[23]	亚历山德鲁·瓦伦汀·杰奥尔杰斯库. 小腿和足部重建的骨整形方法[J].中华显微外科杂志,2022,45(3):241-249. DOI: 10.3760/cma.j.cn441206-20220313-00049.
[24]	赵广跃, 祝勇刚, 杨照. 严重下肢开放性骨折治疗存在的问题和骨整形新策略[J].中华创伤杂志,2020,36(12):1057-1060. DOI: 10.3760/cma.j.cn501098-20200118-00059.
[25]	CullenS, FlahertyD, FitzpatrickN, et al. Outcomes following surgical fixation of Gustilo-Anderson IIIb open tibial fractures[J]. Acta Orthop Belg, 2024,90(1):83-89. DOI: 10.52628/90.1.12387.
[26]	Al-HouraniK, StoddartM, KhanU, et al. Orthoplastic reconstruction of type IIIB open tibial fractures retaining debrided devitalized cortical segments: the Bristol experience 2014 to 2018[J]. Bone Joint J, 2019,101-B(8):1002-1008. DOI: 10.1302/0301-620X.101B8.BJJ-2018-1526.R2.
[27]	OstermannPA, SeligsonD, HenrySL. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases[J]. J Bone Joint Surg Br, 1995,77(1):93-97.
[28]	MartinI, SaraD, MarcoDN, et al. Availability and quality assessment of Clinical Practice Guidelines on orthoplastic surgery treatment of open fractures of the lower limb using AGREE II tool: a systematic review[J]. J Plast Reconstr Aesthet Surg, 2025,100:341-361. DOI: 10.1016/j.bjps.2024.11.061.
[29]	FranklinJL, JohnsonKD, HansenST. Immediate internal fixation of open ankle fractures: report of thirty-eight cases treated with a standard protocol[J]. J Orthop Trauma, 2020,34Suppl 1:S1-S8. DOI: 10.1097/BOT.0000000000001736.
[30]	GopalS, MajumderS, BatchelorAG, et al. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia[J]. J Bone Joint Surg Br, 2000, 82(7):959-866. DOI: 10.1302/0301-620x.82b7.10482.
[31]	康永强, 吴永伟, 芮永军, 等. 表面覆盖抗生素骨水泥的钢板内固定技术一期治疗GustiloⅢB型胫腓骨开放性骨折疗效分析[J]. 中国修复重建外科杂志, 2024, 38(4): 426-431. DOI: 10.7507/1002-1892.202401099.
[32]	赵海磊, 孙志刚, 赵晓慧, 等. 股前外侧穿支皮瓣游离移植联合骨搬运序贯治疗小腿大面积皮肤软组织损伤伴大段胫骨缺损的临床效果[J].中华烧伤与创面修复杂志,2025,41(3):242-250. DOI: 10.3760/cma.j.cn501225-20240926-00350.
[33]	康永强, 芮永军, 吴永伟, 等. 3D打印量化植骨辅助Masquelet技术二阶段治疗Gustilo ⅢB、ⅢC型胫腓骨骨折长段骨缺损的疗效[J].中华创伤杂志,2023,39(3):252-258. DOI: 10.3760/cma.j.cn501098-20221226-00813.
[34]	ZelenskiNA, ArchualA, TangtiphaiboontanaJ, et al. The effect of free versus local flaps on time to union in open tibia fractures[J]. Plast Reconstr Surg, 2023,151(3):655-663. DOI: 10.1097/PRS.0000000000009934.
[35]	YangY, CaoZ, SunN, et al. Clinical effects of different types of flaps selected according to local conditions in the treatment of diabetic foot defects[J]. J Orthop Surg Res, 2024,19(1):634. DOI: 10.1186/s13018-024-05122-y.
[36]	张演基, 李海, 吴祥奎, 等. 游离股前外侧嵌合皮瓣的临床应用与遵义分型[J].中华烧伤与创面修复杂志,2025,41(5):447-453. DOI: 10.3760/cma.j.cn501225-20241108-00438.
[37]	芮永军, 徐永清, 朱庆棠, 等. 严重开放性胫腓骨骨折诊断及早期固定循证指南(2025版)[J].中华创伤杂志,2025,41(11):1021-1034. DOI: 10.3760/cma.j.cn501098-20250812-00440.
[38]	D'CunhaEM, Penn-BarwellJG, McMasterJ, et al. Orthoplastic treatment of open lower-limb fractures improves outcomes: a 12-year review[J]. Plast Reconstr Surg, 2023, 151(2): 308e-314e. DOI: 10.1097/PRS.0000000000009861.
[39]	D'AlleyrandJG, MansonTT, DancyL, et al. Is time to flap coverage of open tibial fractures an independent predictor of flap-related complications?[J]. J Orthop Trauma, 2014,28(5):288-293. DOI: 10.1097/BOT.0000000000000001.
[40]	芮永军, 戚剑, 唐举玉, 等. 严重肢体创伤创面早期修复专家共识[J].中华显微外科杂志,2023,46(4):368-382. DOI: 10.3760/cma.j.cn441206-20230407-00062.