One hundred and two consecutive open fractures of the tibial shaft were
treated from 1970 to 1976. Four required primary amputation. The remainder
received standardized wound care, consisting of surgical debridement and
delayed primary wound closure. Soft-tissue injuries were classified
according to severity, because the initial injury was the most important
prognostic factor. All patients received a seventy-two-hour course of
parenteral antibiotics. Fifty-six fractures were managed with cast
immobilization, thirty-five with rigid internal fixation, and seven with
rigid external pin fixation. The over-all rates of infection (15 per cent)
and delayed union (13 per cent) are not directly comparable to other series
because one must consider the severity of each injury when analyzing
results. Management of the fracture itself should be individualized. The
risk of primary wound closure does not appear to be warranted.