The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage.

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft-tissue loss, and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well-vascularized soft tissue is presented. Eighteen patients with 20 type III and type IIIa wounds were treated in a prospective fashion employing a combined orthopedic and plastic surgical scheme based on the tenets of early radical debridement, a "second look" operation, muscle or muscle-skin flap cover within 5 days of injury, external pin fixation, and ambulation within the first 3 weeks of injury. All fractures united in a mean time of 4.0 months. The mean hospitalization was 4.2 weeks. There have been no chronic infection, osteomyelitis, nonunion, shortening, or tissue breakdown.