Debridement and fixation of an open tibial fracture

Why are we operating?

The bone is the second problem: the operation is the radical cleaning of a contaminated wound, and only then stabilisation with metal outside or inside.

Indication: Open tibial fracture; the timing standard is early antibiotics, timely surgery, and joint orthoplastic decisions.

The operation in 4 steps

1. 01Wound extension and debridement

   The wound is extended along fasciotomy-safe lines and every layer debrided: dead skin, fat, muscle and free bone fragments removed until everything left is healthy.

2. 02Lavage

   Litres of warmed saline irrigate the wound after excision is complete.

3. 03Skeletal stabilisation

   The fracture is stabilised: external fixation when staged or soft tissues are hostile, intramedullary nailing when definitive fixation is right.

4. 04Soft-tissue cover plan

   The wound is dressed or temporised, and definitive cover, direct closure, graft or flap, is planned jointly with plastics within days.

Anatomy you need

The long bones as the plates see them: know each bone's surfaces and which ones carry the soft-tissue windows.

What can go wrong

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.

• Postoperative bleeding

  Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.

• Venous thromboembolism

  Unilateral leg swelling, or sudden dyspnoea, pleuritic pain, tachycardia, sometimes the only sign is unexplained hypoxia.

• Intra-abdominal abscess

  Swinging fevers, malaise, and localized pain from day 5 onward, classically after perforated appendicitis.