As such, antibiotic prophylaxis is usually administered before, during and after intraoperative surgical fixation. Open fractures also result in high rates of infective complications, due to communication with the external environment. The most widely used is the Gustilo-Anderson classification, which describes three groups of increasing severity based on the size of the open wound, the degree of contamination and the extent of the soft-tissue injury 4. Various classification systems have been proposed in literature, in an effort to grade the extent of the initial injury, and to offer useful prognostic clues to aid in deciding on the optimal management 4- 9. ![]() The management of these fractures requires a multidisciplinary approach in order to achieve quick healing and early ambulation for the patient. Thus, the rate of complications associated with open tibial fractures is high infection, non-union and limb loss are the major causes of morbidity 4. Advanced bone reconstruction and soft tissue coverage is usually required to achieve bone and soft tissue healing 3. Prognosis depends on the amount of initial bone displacement, comminution, and soft tissue injury. The management of these fractures can be complex due to the relative lack of soft tissue coverage and blood supply of the tibial shaft 2. The majority of open tibial fractures result from high velocity trauma such as road traffic accidents and falls from height. Tibial fractures are the most common long bone fractures, with around 25% being open fractures 1. Further studies with larger sample sizes are warranted, to determine the significance of fracture location and time taken to fixation on complication rates. Closer monitoring of patients sustaining high grade Gustilo open fractures, as well as antimicrobial prophylaxis for both hospital-acquired organisms and environmental contaminants, will result in the best outcome for patients. The commonest cause of infective complications were hospital-acquired organisms, such as Methicillin-resistant staphylococcus aureus (40.5%). ![]() The fracture location and time taken to fixation did not significantly affect the complication rate, but results were trending towards significance. Patients with Gustilo type III fractures were found to be more than three times as likely to sustain post-operative infective (p=0.007) or bony (p=0.015) complications, compared to Gustilo type I or II fractures. Thirty-one patients (17.9%) had sustained post-operative bony complications, while infective complications were reported in 37 patients (21.4%). All surgical data was gathered retrospectively through online medical records. Over a period of five years, 173 patients had sustained open tibial fractures and undergone operative treatment at a single institution. This study aims to elucidate the risk factors causing these complications, and suggest antimicrobial regimens based on the organisms grown in post-operative infections. Open tibial fractures result in high rates of complications.
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