Lower Extremity Open Fractures Fix and Flap: Does Initial Management in Non-specialized Hospitals Really Compromise its Outcome?

ABSTRACT

Introduction Managing open lower extremity fractures is challenging, with potential complications such as amputation and infection. The aim of the study was to determine whether the time delay and initial treatment of the patients treated in a non-specialized hospital before being transferred to a dedicated level I trauma center led to a worse outcome. Methods Retrospective data from 44 patients (37 males and seven females) undergoing free tissue transfer for lower extremity open fractures from January 2017 to December 2022 were analyzed. Group A received primary care externally and was later transferred for definitive treatment (n=17, 38.6%), while group B received initial care at a level I trauma center (n=27, 61.4%). Surgical outcomes, complications, the duration of the hospital stay, and assessment times were compared. Various demographic variables, co-morbidities, prior interventions, and flap types were analyzed.  Results Average age (A 55.1±16.7; B 38.7±19.8 years; p=0.041), overall hospitalization (A 55.7±22.8; B 42.8±21.3 days; p=0.041), and time to soft tissue reconstruction differed significantly between groups (A 30.7±12.2; B 18.9±9.3 days; p=0.013). Overall, 31.8% had multiple injuries without statistical differences between groups A and B (29.4% vs. 33.3%; p>0.05). There were no statistical differences between the groups in terms of major and minor complications and bone healing characteristics. Limb salvage was successful overall in 93.2% (A 94.1%; B 92.6%; P>0.05). Major complications occurred in 9.1%; three patients underwent major amputation (A n=2; B n=1). Minor complications were observed in 43.2% of patients (partial flap necrosis, wound dehiscence and non-union; A 41.2%; B 44.4%; p>0.05). Overall, 65.9% of patients (A 64.7%; B 66.7%; p>0.05) experienced uneventful bone healing, while 18.2% of patients (A 23.5%; B 14.8%; p>0.05) experienced delayed healing. Flaps used were mostly musculocutaneous (71.7%). Various assessed demographic characteristics, including age and presence of polytrauma, showed no significant influence on complications (p>0.05). Conclusion  Although there is a significant difference in the time course of externally treated patients with open fractures, prolonged treatment is not associated with a higher complication rate or compromised bone healing outcome. Despite the findings, it is important to avoid delays and strive for interdisciplinary collaboration.