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Acta medica Medianae
2018, vol. 57, iss. 4, pp. 22-28
article language: English
document type: Original Scientific Paper
published on: 24/01/2019
doi: 10.5633/amm.2018.0403
Creative Commons License 4.0
Primary wound care and external skeletal fixation in surgical treatment of open tibial fractures
aUniveristy of Niš, Faculty of Medicine
bUniveristy of Niš, Faculty of Medicine + Clinical Centre Niš, Clinic of Orthopaedic and Traumatology
cClinical Centre Niš, Clinic of Orthopaedic and Traumatology
dUniveristy of Niš, Faculty of Medicine + Clinical Centre Niš, Center for Radiology
eUniveristy of Niš, Faculty of Medicine + Clinical Centre Niš, Clinic for General Surgery
fUniversity of Belgrade, Faculty of Medicine, Institute of Orthopedic Surgery 'Banjica'



Virtual human osteoarticular system and its application in preclinical and clinical practice (MESTD - 41017)


Open tibial fractures are the most severe orthopaedic injuries. The lower leg is often injured due to its position in the locomotor system. The injuries of the lower leg skin and soft tissues, bone comminution and threatening infections make the treatment of these fractures particularly complex. The management of open tibial fractures is potentially associated with numerous complications. The data on treatment outcomes of 36 patients operatively treated for the open tibial fractures in Clinic for Orthopaedic surgery and traumatology, Clinical Center Nis in Serbia during the period from January 1, 2012 to June 31, 2014 were retrospectively analyzed and compared. In all the patients, after thorough wound rinsing, removal of the foreign bodies, debridement and delayed wound closure, fractured bone segments were repositioned and stabilized using external fixator. In 28 (77.78%) patients fractures healed without major complications, while in 8 (22.22%) major complications occurred, including tibial osteomyelitis in 3 (8.33%) and fracture malunion in 5 (13.88%) patients. Primary wound care, external fixation, antibiotic and antitetanus prophylaxis are crucial in treatment of open tibial fracture.


Open tibial fractures; primary wound care; external skeletal fixation


Blachut, P.A., Meek, R.N., Brien, O.P.J. (1990) External fixation and delayed intramedullary nailing of open fractures of the tibial shaft: A sequential protocol. J Bone Joint Surg Am, 72(5): 729-35
Caudle, R.J., Stern, P.J. (1987) Severe open fractures of the tibia. J Bone Joint Surg Am, 69(6): 801-7
Court-Brown, C.M., Bugler, K.E., Clement, N.D., Duckworth, A.D., McQueen, M.M. (2012) The epidemiology of open fractures in adults. A 15-year review. Injury, 43(6): 891-897
Court-Brown, C., Keating, J., McQueen, M. (1992) Infection after intramedullary nailing of the tibia. Incidence and protocol for management. Journal of Bone and Joint Surgery. British volume, 74-B(5): 770-774
Court-Brown, C., McBirnie, J. (1995) The epidemiology of tibial fractures. Journal of Bone and Joint Surgery. British volume, 77-B(3): 417-421
Edwards, C.C., Simmons, S.C., Browner, B.D., Weigel, M.C. (1988) Severe open tibial fractures. Results treating 202 injuries with external fixation. Clinical Orthopaedics and Related Research, 230:98-115
Golubović, I., Vukašinović, Z., Stojiljković, P., Golubović, Z., Stamenić, S., Najman, S. (2012) Open segmental fractures of the tibia treated by external fixation. Srpski arhiv za celokupno lekarstvo, vol. 140, br. 11-12, str. 732-737
Golubović, Z., Stojiljković, P., Mačukanović-Golubović, L., Milić, D., Milenković, S., Kadija, M., Matović, Z., Turković, G., Radenković, M., Višnjić, A., Golubović, I., Stojanović, S., Vidić, G., Mitković, M. (2008) Lečenje otvorenih preloma potkolenice metodom spoljne skeletne fiksacije. Vojnosanitetski pregled, vol. 65, br. 5, str. 343-348
Gustilo, R.B., Mendoza, R.M., Williams, D.N. (1984) Problems in the Management of Type III (Severe) Open Fractures. Journal of Trauma: Injury, Infection, and Critical Care, 24(8): 742-746
Kataria, H., Sharma, N., Kanojia, R. (2007) Small Wire External Fixation for High-Energy Tibial Plateau Fractures. Journal of Orthopaedic Surgery, 15(2): 137-143
Kindsfater, K., Jonassen, E.A. (1995) Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma, 9(2): 121-7
Kohlprath, R., Assal, M., kay Uc, ¸.I., Holzer, N., Hoffmeier, P., Suva, D. (2011) Open fractures of the tibia in the adult: surgical treatment and complications. Rev Med Suisse, 7(322): 2482-4
Koval, K.J., Clapper, M.F., Brumback, R.J., Ellison, P. S., Poka, A., Bathon, G. H., Burgess, A.R. (1991) Complications of Reamed Intramedullary Nailing of the Tibia. Journal of Orthopaedic Trauma, 5(2): 184-189
Kreder, H.J., Armstrong, P. (1995) A review of open tibia fractures in children. J Pediatr Orthop, 15(4): 482-8
McKee, M.D., Yoo, D.J., Zdero, R., Dupere, M., Wild, L., Schemitsch, E.H., Mahoney, J. (2008) Combined Single-Stage Osseous and Soft Tissue Reconstruction of the Tibia With the Ilizarov Method and Tissue Transfer. Journal of Orthopaedic Trauma, 22(3): 183-189
Melvin, S.J., Dombroski, D.G., Torbert, J.T., Kovach, S.J., Esterhai, J.L., Mehta, S. (2010) Open Tibial Shaft Fractures: II. Definitive Management and Limb Salvage. American Academy of Orthopaedic Surgeon, 18(2): 108-117
Mitković, M.B., Bumbaširević, M., Golubović, Z., Micić, I., Mladenović, D., Milenković, S., Lešić, A., Bumbaširević, V., Pavlović, P., Karalejić, S., Kuljanin, G., Petković, D. (2005) New concept in external fixation. Acta chirurgica iugoslavica, vol. 52, br. 2, str. 107-111
Swiontkowski, M., Cross, I.W. (2008) Treatment principles in the management of open fractures. Indian Journal of Orthopaedics, 42(4): 377
Yokoyama, K., Itoman, M., Uchino, M., Fukushima, K., Nitta, H., Kojima, Y. (2008) Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing. Indian Journal of Orthopaedics, 42(4): 410