[Treatment guidelines and results in severe open tibial fractures]

27 patients with compound fractures of the lower leg were treated according to the following scheme: Exact excision and surgical cleaning of the wound, reduction of the fragments without further exposure of the bone by additional incision, minimal osteosynthesis, stabilization by means of external fixation device and secondary closure of the accidental wound. During the last year we preferred the V-shaped arrangement in contrast to the tent shaped arrangement of the external fixation device as this minimizes the trauma to the extensor muscles of the foot. After external fixation combined with minimal osteosynthesis (n = 10) the patients had to stay in hospital for 6 weeks only. There was no infection at the incision of neither Steinmann-pins nor Schanz-screws and posttraumatic ostitis only in 1 case was seen. On an average only one secondary operation was necessary, a spongious bonegraft only at 3 patients. On an average the patients had the external fixation device for 5 months, bony union of the fracture was observed after 9 months. In case of external fixation without minimal osteosynthesis (n = 17) the patients had to stay in hospital for 16 weeks, 9 of them had infections at the incision of the Steinmann-pins, 9 of them developed posttraumatic ostitis with fistulae. On an average 4 secondary operations were necessary per patient and 9 patients needed a spongious bonegraft to get bony union of the fracture, which was reached on an average of 17 months.