He had an 11 cm wound over the anterior part of the left lower leg with an open tibia fracture fig 1. Principles include fracture classification, antibiosis, irrigation, debridement, wound management and fracture stabilisation. In this second in a twopart series on open fracture management, debridement, wound management and fracture stabilisation will be explored. Tibia, shaft ao principles of fracture managementthird. This type of fracture is caused by a twisting force. However, circular fixation more commonly has been used for reconstruction of open tibial shaft fractures associated with bone loss or infection. The ideal irrigation solution and pressure remain equivocal.
In their original paper gustilo and anderson stated there is universal agreement that open fractures require emergency. Management of unstable open and closed tibial fractures. Improved understanding of open fracture pathology, techniques of softtissue care, fracture fixation and antimicrobial treatment. Although timely irrigation and debridement within six hours after injury has been established as the standard of care in the management of open tibial fractures, current evidence does not support such practice. We conducted a prospective 6month audit of open tibial diaphyseal fracture management in five plastic surgery units bristol, exeter, plymouth, salisbury, swansea with a collective catchment of 9. Tibial plateau fractures orthopaedic trauma association. The third edition of the book has been fully updated and extended to describe the latest techniques and covers the complete content of the ao principles course of today. Research article management of open tibial shaft fractures. The principles and practice of open fracture care, 2018. It involves the cartilage surface of the knee joint.
The management of these fractures can be complex due to the relative lack of. Anteroposterior and lateral view of tibial spine avulsion fracture in immature skeleton figure 3. The most widely used system is the gustilo and anderson score which is based. Standards for the management of open lower limb fractures bapras. Results treating 202 injuries with external fixation. Pdf complications of open tibial fracture management. Contamination of the fracture site and devitalization of the softtissue envelope greatly increase the risk of infection, nonunion, and wound complications. Furthermore, this study also aims to col etd a nh ur fg ism v complications, in order to recommend targeted antibiotic prophylactic regimes. Tibial shaft fractures management and treatment options. Principles in fractures management linkedin slideshare.
Thirty tibial fractures consisted of closed unstable and open fractures that were managed using the external fixator, emphasizing immediate weight bearing and gradual compression at the fracture site. Our study aimed to present clinical data on the management and outcomes of open tibial shaft fractures. The management of open tibial fractures springerlink. Infection rates of open tibial fractures have been reported to be between 21. Current concepts and technical note on arthroscopic techniques used in management of these injuries vikram sapre and vaibhav bagaria. Update on the management of open lower limb fractures. Open fractures are particularly devastating since the rates of infection and fracture nonunion can be as high as 50% and 18%, respectively. Few studies have examined outcomes when surgical treatment is performed 24 hours after occurrence of. Management of open tibial fractures a regional experience. The fracture line encircles the shaft like the stripes on a candy cane. Complications of open tibial fracture management malaysian. Closed segmental tibial fracture with grade iii soft tissue injury with primary external fixation and secondary plate osteosynthesis.
Twentysix fractures in 23 patients were available for followup evaluation six to 9. Despite the improvements in technology and surgical techniques, rates of infection and nonunion are still troublesome. The management of open fractures continues to provide challenges for the orthopedic surgeon. Current concepts and principles in open tibial fractures part ii. This patients open fracture has been stabilized with external fixation and the wound has been partially closed with antibiotic beads. This study provided an insight into early treatment outcomes and burden of service provision across five plastic surgery units in the southwest of.
The majority of open tibial fractures result from high velocity trauma such as road traffic accidents and falls from height. The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Open fractures of the tibial diaphysis orthopaedic trauma. Open fractures with precarious blood supply and weak soft tissue covering are vulnerable to complications and remain a challenge for every treating surgeon.
Left untreated, open fractures are associated with high rates of morbidity and mortality. Lateral view of tibial spine avulsion fracture in mature skeleton. If a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the. Treatment principles in the management of open fractures. Important principles include antibiotic utilization. The broken end of the tibia shinbone has torn through the soft tissues and is protruding through the skin. The management of open tibial shaft fractures remains challenging. Tibial fractures are the most common long bone fractures, with around 25% being open fractures 1. He was neurovascularly intact with a capillary refill of less than. To receive the best outcome they require the services of both an experienced orthopaedic trauma surgeon and plastic surgeon with an interest in lower limb trauma. Management of open fractures of the tibial shaft in multiple trauma. In this type of fracture, the bone breaks into three or more pieces.
Management of open tibial shaft fractures begins with a thorough patient evalua. The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. Infection rates of open tibial fractures have historically been noted as 1020 times that of other open skeletal fractures 80. Open tibial plateau associated compartment syndrome associated vascular injury. Pdf management of open tibial fracturesa regional experience. Open fractures are often the result of highenergy trauma and can lead to significant longterm morbidity and disability. Updated guidelines for management although timely irrigation and debridement within six hours after injury. Management abstract open fractures of the tibial diaphysis are often associated with severe bone and softtissue injury. Detailed data were collected on patient demographics, injury pattern, surgical management and outcome followed to discharge.
Goals of open fracture management are well known and include the prevention of infection, achievement of bony union, and the restoration of function. Tibial plateau fractures initial management guidelines. Kwasnicki rm, hettiaratchy s, okogbaa j, lo b, yang gz, darzi a. Current treatment strategies in the care of open fractures are continuously studied, improved, and adjusted as our literature base expands. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation. The role of plating in the operative treatment of severe open tibial fractures. A tibial plateau fracture refers to a break or crack in the top of the shin bone, at the knee. Pdf the treatment of softtissue injuries associated with tibial diaphyseal fractures presents a clinical challenge that is best managed by a combined. Evaluation and initial wound management abstract open fractures of the tibial diaphysis are often associated with severe bone and softtissue injury. Rosemont, il, american academy of orthopaedic surgeons, 2016, pp. Open tibial fractures are challenging injuries to deal with.