Grade II Open Tibial Fractures

- See: Gustilo Classification:

- Treatment Options:
     - external fixation:
     - intra-medullary nail;
           - IM devices control length and rotation as effectively as Ex Fix   (w/o complications of soft tissue inpalement & pin tract infection)
           - despite the recent interest in nonreamed interlocking IM nailing for open tibial fractures, there is good evidence to suggest that reamed interlocking
                   nails result in a lower rate of complications (screw breakage) and have a similar time to bone union (Keating JF, et al (1997));
                   - Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. 
           - relative contraindications:
                   - marked delays in treatment (more than 8 - 10 hrs) at which point, the wound may be considered infected (rather than contaminated);
                   - marked contamination of open frx that can't be thoroughly debrided;
                   - exchange IM nailing may be preferable in these cases



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Monday, April 1, 2013 9:37 pm