NONVIABLE INJURIES OF THE TIBIA

Management of severe open fractures and nonviable injuries of the tibi a remain both difficult and controversial. The orthopedist must carefu lly assess the injured limb in order to determine whether it should be salvaged or amputated. The difficult operative procedure requires tho rough knowledge of microsurgical techniques necessary to repair vascul ar and neural injury. Over a 10 year period, 13 patients with non-viab le, open fractures of the tibia underwent limb salvaging attempts usin g identical treatment protocol. 5 of the 13 limbs were salvaged, white 8 limbs were later amputated, because of either failure of revascular ization or severe infection. 2 patients died; one with good circulatio n in the limb because of a massive pulmonary embolism 5 days postopera tively and the other because of severe septicemia 13 days postoperativ ely.