UPDATE ON THE MANAGEMENT OF OPEN FRACTURES OF THE TIBIAL SHAFT

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.