Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries (bullets and blasts), it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, , his family and the community.
OBJECTIVE:
To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage.
PATIENT AND METHODS:
This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula (Gustilo grade II, III) all of them had different degrees of bone loss (more than 5 cm) and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one (9 patients four of them had also associated vascular injury) we did primary below knee amputation, while the second group (16 patients six of them had vascular injury) who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year.
RESULTS:
Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems.
CONCLUSION:
Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula (grade II and III) associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems.