JAAOS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Am Acad Orthop Surg, Vol 18, No 1, January 2010, 10-19.
© 2010 the American Academy of Orthopaedic Surgeons
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Melvin, J. S.
Right arrow Articles by Mehta, S.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Melvin, J. S.
Right arrow Articles by Mehta, S.

Open Tibial Shaft Fractures: I. Evaluation and Initial Wound Management

J. Stuart Melvin, MD, Derek G. Dombroski, MD, Jesse T. Torbert, MD, Stephen J. Kovach, MD, John L. Esterhai, MD and Samir Mehta, MD

From the Department of Orthopaedic Surgery (Drs. Melvin, Dombrowski, Torbert, and Esterhai), the Division of Plastic Surgery (Dr. Kovach), and the Orthopaedic Trauma and Fracture Service (Dr. Mehta), University of Pennsylvania, Philadelphia, PA.

Dr. Mehta or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of AO and Smith & Nephew, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Wolters Kluwer Health–Lippincott Williams & Wilkins. None of the following authors or an immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Melvin, Dr. Dombroski, Dr. Torbert, Dr. Kovach, and Dr. Esterhai.

Open fractures of the tibial diaphysis are often associated with severe bone and soft-tissue injury. Contamination of the fracture site and devitalization of the soft-tissue envelope greatly increase the risk of infection, nonunion, and wound complications. Management of open tibial shaft fractures begins with a thorough patient evaluation, including assessment of the bone and soft tissue surrounding the tibial injury. Classification of these injuries according to the system of Gustilo and Anderson at the time of surgical débridement is useful in guiding treatment and predicting outcomes. Administration of antibiotic prophylaxis as soon as possible after injury as well as urgent and thorough débridement, irrigation, and bony stabilization are done to minimize the risk of infection and improve outcomes. The use of antibiotic bead pouches and negative-pressure wound therapy has proved to be efficacious for the acute, temporary management of severe bone and soft-tissue defects.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2010 by the American Academy of Orthopaedic Surgeons.