Open tibial fractures: An overview

Marios Nicolaides; Georgios Pafitanis; Alexandros Vris

doi:10.1016/j.jcot.2021.101483

Open tibial fractures: An overview

J Clin Orthop Trauma. 2021 Jun 24:20:101483. doi: 10.1016/j.jcot.2021.101483. eCollection 2021 Sep.

Authors

Marios Nicolaides^{1

2}, Georgios Pafitanis^{2

3}, Alexandros Vris^{1

4}

Affiliations

¹ Division of Orthopaedics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
² Group for Academic Plastic Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Department of Plastic and Reconstructive Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK.
⁴ Department of Trauma and Orthopaedic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, UK.

Abstract

Open tibial fractures are complex injuries with multifactorial outcomes and variable prognosis. The close proximity of the tibia to the skin makes it prone to extensive soft tissue damage and subsequent detrimental complications, such as infection and non-union. Thus, they were historically associated with high rates of amputation, sepsis, or even death. The advancement of surgical instruments and techniques, along the emergence of evidence-based guidance, have resulted in a significant reduction in complications. Peculiarly though, modern management strategies have a strong foundation in practices described in the ancient times. Nevertheless, post-operative complications are still a challenge in the management of open tibial fractures. Efforts are actively being made to refine the surgical approaches used, while noteworthy is the emergence of the Orthoplastic approach. The aim of this review is to summarise and discuss the historical perspective of the management of open tibial fractures, their epidemiology and classification, up-to-date principles of surgical management and outcomes following injury.

Keywords: Lower extremity; Open tibial fracture; Orthoplastics; Trauma.