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A sequential protocol for management of severe open tibial fractures
J D Cole1, L J Ansel, R Schwartzberg
1Matthews Orthopaedic Clinic, Orlando, FL 32856-2002, USA.
Clinical Orthopaedics and Related Research
|June 1, 1995
Summary
This study shows that immediate wound coverage and intramedullary nailing effectively treat severe open tibia fractures. This protocol promotes rapid fracture healing with low complication rates in complex cases.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Bone Reconstruction
Background:
- Open tibia fractures present significant challenges in treatment and healing.
- Severe soft tissue damage complicates management and increases infection risk.
Purpose of the Study:
- To evaluate a treatment protocol for open tibia fractures.
- To assess the efficacy of debridement, immediate wound coverage, and intramedullary nailing.
Main Methods:
- Fifty consecutive open tibia fractures (22 Grade IIIB, 4 Grade IIIC) were treated.
- Protocol included debridement, immediate fasciocutaneous flap coverage, and intramedullary nailing.
- Fixation timing and implant selection were based on injury severity and fracture location.
Main Results:
- 98% of fractures achieved union within 6 months.
- Low complication rates: 2% infection, 4% malunion, 2% locking screw breakage.
- Successful management of all open tibia fracture grades, including those with extensive soft tissue injury.
Conclusions:
- Immediate wound coverage and intramedullary nailing are effective for complex open tibia fractures.
- This protocol promotes rapid fracture healing and minimizes complications.
- Intramedullary nailing is a safe and viable option for all grades of open tibial fractures.