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J Am Acad Orthop Surg, Vol 18, No 2, February 2010, 108-117.
© 2010 the American Academy of Orthopaedic Surgeons
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Open Tibial Shaft Fractures: II. Definitive Management and Limb Salvage

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 (Dr. Melvin, Dr. Dombroski, Dr. Torbert, and Dr. Esterhai), the Division of Plastic Surgery (Dr. Kovach), and the Orthopaedic Trauma and Fracture Service (Dr. Mehta), the 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.

Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function. Advances in orthobiologics, modern plastic surgical techniques, and fracture stabilization methods, most notably locked intramedullary nailing, have led to improved prognosis for functional recovery and limb salvage. Despite improved union and limb salvage rates, the prognosis for severe type III open fracture of the tibial shaft remains guarded, and outcomes are often determined by patient psychosocial variables.






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