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Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review
A Myatt1, H Saleeb2, G A J Robertson3
1Department of Trauma & Orthopaedics, ST4 Orthopaedic Registrar Leeds General Infirmary MRCSEd, Great George St, Leeds LS1 3EX, UK.
Introduction:
Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons.
Sources Of Data:
We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures.
Areas Of Agreement And Controversy:
Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate.
Growing Points:
It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage.
Areas Timely For Developing Research:
A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.
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