title: [Changes in therapeutic principles in fractures of the extremities with severe soft tissue injuries exemplified by tibial fracture].
abstract: Functional results after open fractures have been improved during the last decades. Especially the rates of amputation and chronic osteitis after open tibial fractures have been reduced from 30% to less than 5%. The initial management of this type of fracture includes reconstruction of the perfusion of the involved vessels, subsequent debridement with resection of avascular tissues, decompression of compartments by fasciotomy and initial shortening of the tibia by osteotomy and followed by callus distraction in order to achieve the physiological length of the leg. Cortical bone with periostal stripping has to be covered by local muscle transfer or by free vascularized tissue transfer within 3-7 days. Bone defects are either reconstructed by cancellous bone graft or, if the defect is longer than 2 cm, by continuous segmental transfer, according to the technique described by Ilizarov.
authors.affiliation: Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken "Bergmannsheil", Bochum.
authors.forename: A
authors.initials: A
authors.lastname: Dávid
authors.forename: P A
authors.initials: PA
authors.lastname: Ostermann
authors.forename: G
authors.initials: G
authors.lastname: Möllenhoff
authors.forename: D
authors.initials: D
authors.lastname: Hebebrand
authors.forename: G
authors.initials: G
authors.lastname: Muhr
mesh_terms: D000671:Amputation, Surgical; D019072:Antibiotic Prophylaxis; D001852:Bone Lengthening; D003646:Debridement; D019299:Decompression, Surgical; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*