External skeletal fixation and rectus abdominis free-tissue transfer in the management of severe open fractures of the tibia.

The management of severe open fractures of the tibia remains one of the more challenging problems facing the orthopedic surgeon. Patients who sustain high-energy injuries with loss of soft tissue in conjunction with displaced comminuted fractures face high rates of delayed union, nonunion, infection, and in some instances, amputation. This article discusses materials, methods, and surgical techniques.