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Open vs Closed Treatment of Tibial Frx

- Discussion:
    - closed weight bearing treatment should be used for the majority of low energy tibial fractures;
    - advantages of open treatment:
          - allows early weight bearing;
          - minimizes hospitalization;
          - infection;
   - disadvantages of closed treatment:
         - requires compliance w/ wt bearing & cast treatment;
         - malunion occur during casting;
         - subtalar stiffness;
    - disadvantages of open treatment:
         - plate fixation:
              - risks wound dehiscence & infection;
              - delayed wt bearing & refracture (following plate removal) are common;
         - external fixation:
              - requires frequent adjustments;
              - pin tract infections;
              - malunion may occur w/ change of Ex Fix to Cast;
              - high infection rate may occur w/ change of ExFix to IM nailing, (especially with pin tract infections)

Posterolateral bone graft of the tibia.

Early prophylactic bone grafting of high-energy tibial fractures.

Acute and definitive management of traumatic osteocutaneous defects of the lower extremity.

Locked intramedullary nailing of open tibial fractures.