Dc. Templeman et al., UPDATE ON THE MANAGEMENT OF OPEN FRACTURES OF THE TIBIAL SHAFT, Clinical orthopaedics and related research, (350), 1998, pp. 18-25
A retrospective study of 133 open tibial fractures in 129 patients tre
ated at the Hennepin County Medical Center between 1986 and 1993 was d
one. The results of the treatment protocol in this patient group is pr
esented and the current classification schemes, prevention of infectio
n, debridement, antibiotics, soft tissue reconstruction, fracture stab
ilization methods, bone grafting, and exchange nailing are discussed.
Recent studies that have documented interobserver disagreement in the
classification of open fractures underscore the difficulties encounter
ed in the initial assessment and treatment of open tibial shaft fractu
res. Despite repetitive and aggressive debridement, a certain number o
f fractures will remain contaminated and become infected. Infection af
ter these severe injuries is probably multifactorial, and its preventi
on requires that the surgeon diligently adhere to the imperatives of o
pen fracture care.