![]() ![]() 3 This practice continued for centuries until the renowned French barber-surgeon Ambroise Paré introduced the concept of wound dilatation and removal of bone fragments ( Fig. 1). 2, 3 Thousands years later, Hippocrates suggested cleansing and sealing the open fracture wound, reducing the fracture after 7–10 days using iron levers and sawing off any protruding bones. The first reported open fracture dates back to 3000-2500 BC and is believed to be Case 37 in the Edwin Smith Papyrus ( Fig. 1). We have been differentiating between open and closed fractures for more than 4500 years now. The aim of this review is to summarise and discuss the historical perspective of the management of open tibial fractures, their epidemiology and classification, up-to-date principles of surgical management and outcomes following injury.Ģ. Historical perspective: 3000BC to World War II Noteworthy has also been the emergence of the Orthoplastic approach, where orthopaedic and plastic surgeons co-jointly manage cases both inside and outside the operating theatre. The publication of evidence-based guidelines by professional organisations globally, along the advancement of surgical instruments and techniques, have resulted in a significant reduction in amputation, mortality, and infectious complications. Their perplexity is caused by the wound itself, which predisposes the fracture site to detrimental complications, such as infection and non-union. 1 Open tibial fractures have always been a challenge to manage, as historically they often resulted in amputation, sepsis or even death. The majority of open fractures are those of the long bones, while most occur in the lower extremity and particularly the tibia. Open fractures can be defined as fractures which communicate with the outside environment through a soft tissue wound. The aim of this review is to summarise and discuss the historical perspective of the management of open tibial fractures, their epidemiology and classification, up-to-date principles of surgical management and outcomes following injury. Efforts are actively being made to refine the surgical approaches used, while noteworthy is the emergence of the Orthoplastic approach. Nevertheless, post-operative complications are still a challenge in the management of open tibial fractures. Peculiarly though, modern management strategies have a strong foundation in practices described in the ancient times. ![]() The advancement of surgical instruments and techniques, along the emergence of evidence-based guidance, have resulted in a significant reduction in complications. Thus, they were historically associated with high rates of amputation, sepsis, or even death. The close proximity of the tibia to the skin makes it prone to extensive soft tissue damage and subsequent detrimental complications, such as infection and non-union. Open tibial fractures are complex injuries with multifactorial outcomes and variable prognosis. ![]()
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