- 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 (J.F. Keating et al, JBJS 1997);
- 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;
