Modern Principles in the Acute Surgical Management of Open Distal Tibial Fractures.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
01 Jun 2021
01 Jun 2021
Historique:
received:
12
08
2020
accepted:
08
02
2021
pubmed:
1
4
2021
medline:
29
7
2021
entrez:
31
3
2021
Statut:
ppublish
Résumé
Over the past two decades, management of open distal tibial fractures has evolved such that a staged approach, with external fixation and débridement during the index procedure, followed by definitive fixation and wound closure at a later date, is often considered the standard of care. Although definitive treatment of these complex injuries is often done by a multidisciplinary team of surgeons well versed in periarticular fracture repair and soft-tissue coverage in the distal extremity, the on-call orthopaedic surgeon doing the index procedure must understand the principles and rationale of the staged treatment algorithm to avoid compromising definitive treatment options and ensure the best possible patient outcome. The mechanism of injury, neurovascular status, size and location of soft-tissue injury, fracture pattern, and concomitant injuries in the polytraumatized patient should direct the treatment plan and anticipated outcomes. This review focuses on evaluation and management of these complex injuries with an emphasis on early aggressive débridement, principles of initial fracture fixation, and modern options for soft-tissue coverage, including local and free tissue transfer.
Identifiants
pubmed: 33788807
doi: 10.5435/JAAOS-D-20-00502
pii: 00124635-202106010-00006
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e536-e547Informations de copyright
Copyright © 2021 by the American Academy of Orthopaedic Surgeons.
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