Management of gunshot wounds to the tibia.

The management of tibial gunshot wounds is unique because of the close proximity of the medial aspect of the bone to the skin. The minimal soft-tissue sleeve covering the medial tibia allows bullets to enter medially and strike the bone with greater energy and allows surface contaminants to reach the bone readily unlike areas such as the thigh where soft tissue can dissipate much of the energy. The consequence of this anatomic difference may affect infection rates, fracture stability, and surgical options. For these reasons, tibial gunshot wounds should be treated independently from other gunshot wounds to the extremity.