Fix and Flap: The Radical Orthopaedic and Plastic Treatment of Severe Open Fracture of the Tibia

Abstract

Eighty-four severe, open tibial fractures in 80 patients were treated aggressively with immediate radical wound debridement with profuse lavage and either internal fixation (nails or plates) or external fixation followed by early soft-tissue cover with a muscle flap. A combined orthopaedic and plastic surgery approach was employed. Immediate soft-tissue coverage resulted in better overall outcomes than when coverage was delayed. In those fractures receiving immediate soft-tissue coverage (< 24 hours versus early, < 72 hours, or late, > 72 hours), no amputations were necessary, time to union was less, and fewer infections occurred. Furthermore, regardless of the timing of soft-tissue coverage, internal fixation achieved better overall results in regards to time to union and complications as compared with external fixation. For the treatment of these severe fracture types, primary referral to a specialist center whenever possible is highly recommended.