The importance of the blood supply in the healing of tibial fractures.

A clinical study of the effects of nonischemic arterial injuries to the leg on tibial fracture healing is presented. In addition, the literature published during the past 100 years describing the vascular supply to the tibia is reviewed, and the San Francisco General Hospital treatment protocol for difficult open tibial fractures is outlined. Based on the finding that the delayed and nonunion rate is three times higher when one of the three arteries of the leg is disrupted, a modification of the Gustilo fracture classification is proposed.