This is a retrospective study of 104 open fractures of the tibial shaft
seen at a civilian teaching center. Seventy-one per cent of the fractures
resulted from vehicular accidents. Twenty-seven per cent of the fractures
did not unite and half of these non-unions were infected. Virtually all of
the ununited tibial fractures were associated with fractures of the fibula
and with extensive avulsions of skin and dirty wounds. Although a variety
of techniques for care of the wound and treatment of the fracture was used,
none was entirely successful. Some failures were attributable to
inadequacies of wound care--either premature primary closure or failure to
perform secondary skin closure. Other failures of treatment were associated
with use of internal fixation. Early weight-bearing without internal
fixation, however, did not uniformly result in union.