Management of Gustilo–Anderson IIIB open tibial fractures in adults—a systematic review

• Published in: British medical bulletin 2021-09, Vol.139 (1), p.48-58
• Main Authors: Myatt, A, Saleeb, H, Robertson, G A J, Bourhill, Jana Keren, Page, P R J, Wood, A M
• Format: Article
• Language: English
• ISSN: 0007-1420; 1471-8391
• DOI: 10.1093/bmb/ldab013

INTRODUCTIONOpen tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. SOURCES OF DATAWe searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. AREAS OF AGREEMENT AND CONTROVERSYInfection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. GROWING POINTSIt is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. AREAS TIMELY FOR DEVELOPING RESEARCHA national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.