Eleven patients with Gustilo IIIC fractures with a medial wound and vascular injury were included in this series from 2003- 2009. Seven of these patients had the vascular repair done by the surgeon doing the bone fixation.
The patients are positioned supine and the involved side is brought to the edge of the table with a sand bag placed deep under the ipsilateral buttock. A fasciotomy is undertaken. The original wound on the medial side is debrided and vascular control is obtained. The Vastus medialis is lifted off the medial inter-muscular septum and the bone ends are delivered, irrigated and retrograde insertion of the K- nail is done. When the nail is protruding, the leg is adducted and the nail driven in fully. The fracture is reduced and the antegrade insertion of the K-nail is done. The vascular repair with a reverse saphenous vein graft is done thereafter.
Of the 11 patients, one developed non-union and one developed a superficial wound infection. Sixteen patients who had external fixation of Gustilo IIIC fractures of the femur during the same period of time in the same unit, all needed subsequent ORIF and six developed pin site infection.
This technique is quick and gives stability for a vascular repair. When the wound is on the medial side, this prevents an additional incision and allows vascular access through the same. Harvesting of the venous graft is made easy as the patient is supine.