title: Open tibial shaft fractures: II. Definitive management and limb salvage.
abstract: Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function. Advances in orthobiologics, modern plastic surgical techniques, and fracture stabilization methods, most notably locked intramedullary nailing, have led to improved prognosis for functional recovery and limb salvage. Despite improved union and limb salvage rates, the prognosis for severe type III open fracture of the tibial shaft remains guarded, and outcomes are often determined by patient psychosocial variables.
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: D000671:Amputation, Surgical; D000818:Animals; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D001860:Bone Plates; D016267:External Fixators; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D011379:Prognosis; D011859:Radiography; D019651:Plastic Surgery Procedures; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D019485:Bone Morphogenetic Proteins