This narrative review from the University of Pennsylvania covers the initial evaluation and wound management of open tibial shaft fractures — the most common open long bone fracture — addressing systematic assessment, Gustilo-Anderson classification, antibiotic prophylaxis timing, débridement and irrigation technique, and adjunctive wound coverage strategies.
When you encounter an open tibial fracture, classify it definitively in the OR at the time of débridement, push antibiotics within 3 hours, use low-pressure irrigation (volume scaled to grade), and reserve antibiotic bead pouches for severe contamination or inadequate soft-tissue coverage — but remember that even with a VAC in place, definitive soft-tissue coverage must happen within 7 days to keep infection rates acceptable.
This narrative review from the University of Pennsylvania covers the initial evaluation and wound management of open tibial shaft fractures — the most common open long bone fracture — addressing systematic assessment, Gustilo-Anderson classification, antibiotic prophylaxis timing, débridement and irrigation technique, and adjunctive wound coverage strategies.
When you encounter an open tibial fracture, classify it definitively in the OR at the time of débridement, push antibiotics within 3 hours, use low-pressure irrigation (volume scaled to grade), and reserve antibiotic bead pouches for severe contamination or inadequate soft-tissue coverage — but remember that even with a VAC in place, definitive soft-tissue coverage must happen within 7 days to keep infection rates acceptable.