Induced Angular Deformity and Acute Shortening for Primary Wound Closure in a IIIB Open Proximal Tibia Fracture

Treatment of open high-energy segmental proximal tibia fractures is complicated by a compromised, and often deficient, soft tissue envelope. Although soft tissue defects in the proximal third of the leg can be readily addressed with local soft tissue flaps, these come with their own functional morbidity. With induced angular deformity and axial shortening, circular external fixation can be used to concomitantly treat the soft tissue and bone injuries with primary wound closure and ipsilateral distraction. This article describes the treatment of a Proximal tibia fracture, high-energy open segmentalHigh-energy open segmental proximal tibia fracturehigh-energy open segmental proximal tibia fracture with soft tissue compromise. After initial debridement, the extremity was acutely shortened and angulated through the fracture site to allow primary wound closure. The induced deformity was statically held with a circular external fixator (Taylor Spatial Frame) for several weeks to allow adequate soft tissue healing; then, gradual angular correction was performed. The axial shortening was corrected through concomitant ipsilateral lengthening of the distal tibia.