KẾT QUẢ ĐIỀU TRỊ GÃY HỞ IIIB THÂN HAI XƯƠNG CẲNG CHÂN TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

Abstract

Introduction: Open tibial shaft fractures grade IIIB according to Gustilo–Anderson classification remain a major challenge in orthopedic trauma due to high risks of infection, delayed union, and soft tissue complications. This study aimed to evaluate the treatment outcomes of type IIIB open fractures of both tibia and fibula shafts managed at Viet Duc University Hospital. Methods: A prospective–retrospective descriptive study was conducted on 55 patients with Gustilo–Anderson type IIIB open fractures of both tibial shafts treated at Viet Duc University Hospital between June 2024 and June 2025. All patients underwent emergency wound debridement and external fixation of the tibia. Initial fracture reduction was assessed using Larson and Bosman’s criteria; bone healing was evaluated with the RUST score; flap outcomes at 2 weeks and 2 months were assessed by Neale W.H.’s criteria; and functional recovery was measured by the Lower Extremity Functional Scale (LEFS). Results: Initial fracture reduction was rated as excellent or good in 78,2% of cases. The mean RUST score was 7,21 ± 1,95. Bone healing outcomes were good in 14,6%, fair in 47,9%, with delayed union observed in 51,2% and nonunion in 35,3%. Flap survival was rated good or fair in 89,09% of cases. The mean LEFS score was 48,47 ± 12,94, with 79,3% of patients achieving minimal to mild functional limitation. Overall infection rate was 36,4%, pin tract infection 23,6%, and amputation 3,6%. Conclusion: Surgical management of Gustilo–Anderson type IIIB open tibial shaft fractures with early debridement, external fixation, and flap coverage achieved acceptable fracture reduction, satisfactory flap survival, and functional recovery in the majority of cases. However, high rates of infection, delayed union, and nonunion highlight the need for further improvements in treatment strategies and long-term follow-up.