Management of open tibial fractures

open tibial fractures are challenging injuries to manage. The Gustilo classification has been the most widely used system and is generally accepted as the primary classification system for open fractures. This system takes into consideration the energy of the fracture, soft-tissue damage, and the degree of contamination. It has been modified since the original classification to allow a more accurate prognosis for more severe injuries (i.e., Type III injuries).The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function.The optimal method of skeletal stabilisation is controversial with some authors advocating reamed nailing, some unreamed nailing, some external fixation and now with the advent of minimally invasive locking plates, a further option has been added to the surgeon’s choices. Different grades of open tibial fracture may demand different methods of skeletal stabilisation.Locked intramedullary nailing remain the ministary of treatment of open tibial shaft fractures specially type I and II fractures. The choice in type IIIA-C is external fixator. There has been considerable debate in the literature regarding reamed and nonreamed intramedullary nail.Recently, in open fractures associated with severe bone lose or infection, it is wise to use ring external fixator (Ilizarof) as acute definitive stabilization methods.