Management of Grade Iii a and Iii B Tibial Fractures: A Comparison Between Vacuum Assisted and Conventional Therapy

Background: Fractures accompanied by an open wound, at or near the fracture site are called open or compound. The simultaneous exposure of tissue and bone poses specific management challenges. As with most wounds, damage to the soft tissue increases the risk of infection. The severity of open fractures is generally assessed using the Gustilo-Anderson open fracture classification system. Objective: To compare the outcomes of vacuum assisted therapy and standard normal saline dressing in the management of Gustilo Anderson compound grade IIIA and IIIB fractures of tibia. Study Design, Settings And Duration: Randomized Control Trial, conducted at Department of Orthopaedics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over Six months duration (20th March, 2020 to 19th Sep2020). Materials And Methods: All patients who fulfilled the inclusion criteria were included in the study after Informed consent. Patients were randomly assigned into two study groups i.e. Group A (vacuum assisted therapy) and Group B (conventional dressing). The study outcomes were measured in terms of length of hospital stay and wound infection rate for one month follow up. Results: The age of group A patients was 35.6±9.8 years and 33.7±8.4 years in group B patients. There were 35 (68.6%) male and 16 (31.4%) females in group A whereas 33 (64.7%) male and 18 (35.3%) females in group B. The hospital stay in vacuum assisted therapy group was13.1±5.6 days whereas it was12.4±5.1days in conventional dressing group, the difference was non-significant statistically (P=0.510). Wound infection was observed in 10 (19.6%) patients of group A and 6 (11.8%) patients of group B which was statistically non-significant (P=0.207). Conclusion: The vacuum assisted therapy and standard normal saline dressing are equally effective in the management of grade IIIA and IIIB Tibial fractures with no significant difference.