Non-union in open tibial fractures.

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.