7. Conclusions

From previous studies, we know that in case of limb conservation, we will face a secondary amputation rate of 3.9%, a complication rate near 40% (10% infections), a 24% non-union rate and an 8% of long-term osteomyelitis. In the case of amputation, we have to consider a reamputation rate of 5.4% and a 25% complication rate in the first 3 months (1/3 infections). At 7 years post-injury, patients treated with amputation or limb salvage procedure were found to have similarly poor outcomes [62], but costs were higher for amputee patients because of the

The factors that can modify outcomes, in patients with mangled extremities, are numerous: tobacco consumption is one of the most important, with an increase of 37% in the non-union rate, an increase higher than two times in infection and almost four times in osteomyelitis. Ceasing smoking will improve the union rate, the infection rate and the risk of osteomyelitis, but patients will never have the same risk as a non-smoker. Personal status, education level, gender, age, economic status and patient self-esteem are pre-lesional factors, and worker compensations, depression, SIP score, walking speed, pain and aggressive physiotherapy are

Complication rates in open fractures are dependent on the type of injury. Commonly, we can say that complication rates increase with the Gustilo classification [13, 69]. We can expect a high complication rate for most grade III open fractures, but only a small increase in compli-

For grade I fractures, we can assume a complication rate near close fractures, if they are

In grade II fractures, the complication rate would be slightly higher than seen in close fractures or grade I [13]. We will appreciate a low increase in the infection rate, and patients would experience a delay in the time until full recovery [70, 71]. In these situations, the use of a plate,

In the case of tibial open fractures, from grades IA to IIIA, if they can be managed initially by a nail, with a proper protocol, the complication rate would be similar to close fractures in the

In limb-threatening injuries, if we choose a salvage procedure, we can expect a high complication rate. If we look for the lower extremity assessment project (LEAP) study group outcomes, we will find wound infections in 23% of patients, 31% of non-unions, 5% of malunions and 9% of osteomyelitis [73] in these injuries. These complications would decrease functions in these patients. Complications would also favor the development of secondary complications, for example, if a patient suffers an infection, he/she will also increase the non-union and delay healing rate

cost of the prostheses [63].

32 Trauma Surgery

6. Complications

post-lesional factor that will modify the outcomes [64–68].

managed in a proper way, and patients will recover fast [70].

if indicated, would not increase the infection rate [71].

cations for grade I and II open fractures [69].

first 30 days after the injury [72].

(with an odds ratio higher than 4) [74].

Open fractures can produce a huge disability in patients. The use of evidence-based protocols and treatments will help us to optimize patient's outcomes. Centers used to manage highenergy trauma with an "orthoplastic" team will achieve the best results in open fractures, specially grade III, and will be prepared to manage the devastating complications that will appear during the reconstructive steps of these fractures.
