150 open fractures of the tibial shaft--the relation between necrosis of the skin and delayed union.

In 150 open fractures of the tibial shaft a close relationship between the presence of skin necrosis and delayed union was found. The incidence of skin necrosis rose with the severity of trauma. It was high (22 per cent) among the fractures that were treated conservatively, but even higher (41 per cent) among those treated with primary osteosynthesis. Neither conventional conservative treatment nor osteosynthesis seems to be satisfactory as a primary treatment of the most severe cases. It is instead suggested that external fixation by the Hoffmann-Vidal technique should be combined with transposition of viable muscle tissue across denuded fractured bone areas according to the method of Ger.