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Utilizing the various forms of the gastrocnemius muscle in fix & flap protocol: a reliable remedy for open proximal tibial fractures with accompanying soft tissue defect

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Open proximal tibial fractures accompanied by soft tissue loss are substantially challenging to accomplish both bony consolidation and wound healing. The authors retrospectively delineated the utility of the various forms of the gastrocnemius muscle in fix & flap regimen for management of such complicated injuries.

Methods

Thirty-one patients with open fracture accompanied by soft tissue loss of proximal tibia were managed by the protocol of fix & gastrocnemius flap. The collected data included implant for fixation, form of the gastrocnemius flap, postoperative complications, union time, and clinical assessment.

Results

According to fixation devices, lateral anatomical locking compression plates were selected in 28 cases, dual plates in 1, and interlocking nails in 2. According to the forms of the gastrocnemius flap, medial gastrocnemius flap was utilized in 22 cases, medial hemigastrocnemius flap in 2, medial myocutaneous gastrocnemius flap in 2, lateral gastrocnemius flap in 3, and combined medial and lateral gastrocnemius flaps in 2. All flaps completely survived without any flap-related complications. Fracture consolidation was established in all patients with an average period of 19.9 weeks (range 16–26). Surgical site infection occurred in 3 cases, and delayed union in 1. By functional score of Puno, 3 cases were determined to be excellent, 27 to be good, and 1 to be fair.

Conclusion

Concurrent use of internal fixation and gastrocnemius flap reconstruction is a reliable and efficient protocol in managing open fractures with accompanying soft tissue defect of proximal tibia.

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Funding

There was no source of funding for this research.

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Authors and Affiliations

  1. Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, 65000, Thailand

    Surasak Jitprapaikulsarn, Kritsada Sukha, Chawanan Patamamongkonchai, Arthit Gromprasit & Witoon Thremthakanpon

Authors
  1. Surasak Jitprapaikulsarn
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  2. Kritsada Sukha
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  3. Chawanan Patamamongkonchai
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  4. Arthit Gromprasit
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  5. Witoon Thremthakanpon
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Contributions

SJ was involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis and interpretation of data, as well as acquisition of the data. KS, CP, AG and WT were involved in revising the manuscript for content and analysis and interpretation of data.

Corresponding author

Correspondence to Surasak Jitprapaikulsarn.

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Conflicts of Interest

S. Jitprapaikulsarn, K Sukha, C Patamamongkonchai, A. Gromprasit and W. Thremthakanpon declare that they have no conflict of interest.

Ethical approval

This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Jitprapaikulsarn, S., Sukha, K., Patamamongkonchai, C. et al. Utilizing the various forms of the gastrocnemius muscle in fix & flap protocol: a reliable remedy for open proximal tibial fractures with accompanying soft tissue defect. Eur J Orthop Surg Traumatol 32, 505–513 (2022). https://doi.org/10.1007/s00590-021-03013-0

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  • DOI: https://doi.org/10.1007/s00590-021-03013-0

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