title: Open tibial shaft fractures: I. Evaluation and initial wound management.
abstract: Open fractures of the tibial diaphysis are often associated with severe bone and soft-tissue injury. Contamination of the fracture site and devitalization of the soft-tissue envelope greatly increase the risk of infection, nonunion, and wound complications. Management of open tibial shaft fractures begins with a thorough patient evaluation, including assessment of the bone and soft tissue surrounding the tibial injury. Classification of these injuries according to the system of Gustilo and Anderson at the time of surgical débridement is useful in guiding treatment and predicting outcomes. Administration of antibiotic prophylaxis as soon as possible after injury as well as urgent and thorough débridement, irrigation, and bony stabilization are done to minimize the risk of infection and improve outcomes. The use of antibiotic bead pouches and negative-pressure wound therapy has proved to be efficacious for the acute, temporary management of severe bone and soft-tissue defects.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Melvin
authors.forename: Derek G
authors.initials: DG
authors.lastname: Dombroski
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Torbert
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.forename: John L
authors.initials: JL
authors.lastname: Esterhai
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000465:Algorithms; D019072:Antibiotic Prophylaxis; D001843:Bone Cements / Q000627:therapeutic use; D003646:Debridement; D005597:Fractures, Open / Q000145:classification / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D054843:Negative-Pressure Wound Therapy; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D007507:Therapeutic Irrigation; D013978:Tibial Fractures / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D014945:Wound Healing
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate