Management of complex open tibial fractures with external skeletal fixation and early myoplasty or myocutaneous coverage.

The management of severe open fractures is difficult. The high energy forces cause considerable comminution, displacement and extensive soft tissue damage with associated skin loss, all of which complicate treatment. The authors review the role of the soft tissues in the healing process of complex, open fractures with special emphasis on the concept of the "open fracture wound". A surgey of the published results of the treatment of severe open tibial fractures provides the background for an approach to the management of these severe fractures by stable external fixation with early myoplasty or myocutaneous coverage; this is a departure from traditional orthopedic methods of treatment. The authors present their prospective treatment protocol and review the results in the first eight patients managed by this method.