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. 2021 Jun 24:20:101483.
doi: 10.1016/j.jcot.2021.101483. eCollection 2021 Sep.

Open tibial fractures: An overview

Marios Nicolaides  1   2 , Georgios Pafitanis  2   3 , Alexandros Vris  1   4
Affiliations

Open tibial fractures: An overview

Marios Nicolaides et al. J Clin Orthop Trauma. .

Abstract

Open tibial fractures are complex injuries with multifactorial outcomes and variable prognosis. The close proximity of the tibia to the skin makes it prone to extensive soft tissue damage and subsequent detrimental complications, such as infection and non-union. Thus, they were historically associated with high rates of amputation, sepsis, or even death. The advancement of surgical instruments and techniques, along the emergence of evidence-based guidance, have resulted in a significant reduction in complications. Peculiarly though, modern management strategies have a strong foundation in practices described in the ancient times. Nevertheless, post-operative complications are still a challenge in the management of open tibial fractures. Efforts are actively being made to refine the surgical approaches used, while noteworthy is the emergence of the Orthoplastic approach. The aim of this review is to summarise and discuss the historical perspective of the management of open tibial fractures, their epidemiology and classification, up-to-date principles of surgical management and outcomes following injury.

Keywords: Lower extremity; Open tibial fracture; Orthoplastics; Trauma.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Timeline of the advancement of open fracture management until the 19th century.
Fig. 2
Fig. 2
Gustilo-Anderson Type I open tibial fracture.
Fig. 3
Fig. 3
Gustilo-Anderson Type II open tibial fracture – (A) Before management; (B) Immediate post-operative result after bone fixation and soft tissue reconstruction.
Fig. 4
Fig. 4
Gustilo-Anderson Type IIIA open tibial fracture – (A) Before management; (B) Immediate post-operative result after bone fixation and soft tissue reconstruction.
Fig. 5
Fig. 5
Gustilo-Anderson Type IIIB open tibial fracture – (A) Following surgical debridement and temporary spanning external fixation; (B) Immediate post-operative result (‘fix and flap’); (C) One-week post-operative result.
Fig. 6
Fig. 6
Fracture of the lower one third of the left tibia – (A) X-ray on admission; (B) Skeletal fixation using an intramedullary nail, post-operative x-ray.
Fig. 7
Fig. 7
High-energy Gustilo-Anderson Type II distal tibial fracture – (A) showing necrotic eschar pre-debridement; (B) healthy, vascularised soft tissue and bone post-debridement.
Fig. 8
Fig. 8
Negative pressure dressings in the form of VAC™.
Fig. 9
Fig. 9
Recommendations for use of flaps in definitive soft tissue closure of small and medium defects in the lower extremity.
Fig. 10
Fig. 10
Fasciocutaneous-muscle anterolateral thigh flap used in free tissue transfer for definitive wound coverage of a large defect in a Gustilo-Anderson type IIIC open tibial fracture.
Fig. 11
Fig. 11
Circular external fixators are used for definitive skeletal stabilisation of open bone fractures – (A) Fixator on an artificial bone model; (B) Post-operative x-ray of a lower open tibial fracture managed with external fixation.
Fig. 12
Fig. 12
Infections of the soft tissue following management of open tibial fractures – (A) Superficial infection; (B) Deep infection.
Fig. 13
Fig. 13
Schematic for differentiating between superficial and deep infection.
See this image and copyright information in PMC

References

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