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1General considerations

Tibia with bone loss and space filled with antibiotic beads

Management of open tibial fractures can be challenging. In some situations, primary amputation may be necessary.
While most open tibial fractures can be managed satisfactorily , those which are more severe, pose serious challenges and may have poor results.

Infection
The grade of open fracture, condition of the soft tissues, degree of contamination and the thoroughness of surgical debridement will have influence on the risk of infection. In the worst injuries (type III b or c), open tibial fractures carry an infection risk of up to 25-50 %. (1)

Soft-tissue deficiency
Loss or irreparable damage to the soft-tissue envelope is a frequent feature of severe open tibial fractures. This may result directly from the injury or from delayed wound necrosis. Soft-tissue defects require early closure with healthy tissue to reduce the risk of infection. Local or free-tissue transfers may be required, if tension-free closure is not possible.

Impaired bone healing
Delay or failure of bone healing is common with open tibial fractures. Average time to union is about a year (2). Failure to unite may require additional surgery, such as bone grafting and/or revised fixation. Stimulation of bone healing remains a developing field.