title: The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage.
abstract: Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft-tissue loss, and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well-vascularized soft tissue is presented. Eighteen patients with 20 type III and type IIIa wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or muscle-skin flap cover within 5 days of injury, external pin fixation, and ambulation within the first 3 weeks of injury. All fractures united in a mean time of 4.0 months. The mean hospitalization was 4.2 weeks. There have been no chronic infection, osteomyelitis, nonunion, shortening, or tissue breakdown.
mesh_terms: D000328:Adult; D001858:Bone Nails; D003238:Connective Tissue; D003646:Debridement; D004434:Early Ambulation; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*