J Am Acad Orthop Surg 2021 Mar 31. Epub 2021 Mar 31.
From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Shafiq), the Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY (Hacquebord), and the Department of Orthopaedic Surgery, University of California, School of Medicine, Los Angeles, CA (Wright and Gupta).
Over the past two decades, management of open distal tibial fractures has evolved such that a staged approach, with external fixation and débridement during the index procedure, followed by definitive fixation and wound closure at a later date, is often considered the standard of care. Although definitive treatment of these complex injuries is often done by a multidisciplinary team of surgeons well versed in periarticular fracture repair and soft-tissue coverage in the distal extremity, the on-call orthopaedic surgeon doing the index procedure must understand the principles and rationale of the staged treatment algorithm to avoid compromising definitive treatment options and ensure the best possible patient outcome. The mechanism of injury, neurovascular status, size and location of soft-tissue injury, fracture pattern, and concomitant injuries in the polytraumatized patient should direct the treatment plan and anticipated outcomes. Read More