McMaster University

McMaster University

Open Tibial Fractures: Updated Guidelines for Management

We are pleased to share with you a recent publication in the The Journal of Bone and Joint Surgery Reviews. This publication is entitled "Open Tibial Fractures: Updated Guidelines for Management"

Find abstract below and please click here to access the full-version of the article.

Mundi R, Chaudhry C, Niroopan G, Petrisor B, Bhandari, M. Open Tibial Fractures: Updated Guidelines for Management. JBJS Reviews. 2015 Feb; 3(2).


➢ Although timely irrigation and debridement within six hours after injury has been established as the standard of care in the management of open tibial fractures, current evidence does not support such practice. The ideal irrigation solution and pressure remain equivocal.

➢ Antibiotic prophylaxis should be commenced as soon as possible. All patients should receive antimicrobial coverage against gram-positive bacteria, typically with a first-generation cephalosporin. Gustilo and Anderson type-III injuries require additional coverage, and it is reasonable to use an aminoglycoside, although the optimal regimen has not conclusively been established. Local antibiotic administration at the site of injury, as an adjunct to systemic prophylaxis, considerably reduces the risk of infection, and the benefit is most pronounced for type-III injuries.

➢ Both reamed and unreamed intramedullary nailing are reasonable options for fracture fixation of open tibial fractures and have demonstrated comparable outcomes. Although external fixation should not typically be used as definitive fixation, it is a useful temporizing measure in more severe injuries when it is used for a short duration of time (i.e., twenty-eight days or less).

➢ Primary wound closure is recommended for fractures with less severe soft-tissue injury, allowing for tension-free closure. For those injuries requiring delayed closure, definitive coverage should not be delayed beyond seven days, even in the setting of negative-pressure wound therapy.

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