Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time? OTA International: The Open Access Journal of Orthopaedic Trauma. The tibia and fibula are joined at the syndesmosis, a very strong fibrous structure comprised of the anterior inferior tibiofibular ligament (AITFL). Management of Gustilo–Anderson IIIB open tibial fractures in adults-a systematic review. Myatt A, Saleeb H, Robertson GAJ, Bourhill JK, Page PRJ, Wood AM. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time? OTA International: The Open Access Journal of Orthopaedic Trauma. These classification systems provide information about. Clinical Orthopaedics & Related Research. For pilon fractures (that are axial injuries), the Ruedi-Allgower and AO Muller classifications prevail. Current concepts and ongoing research in the prevention and treatment of open fracture infections. Grade IIIC fractures specifically require vascular intervention, since the fracture is associated with vascular injury to the extremity.Grade IIIB fractures have significant soft-tissue damage or loss, such that bone is exposed, and reconstruction may require a soft-tissue transfer (flap) to be performed in order to cover the wound.Most surgeons classify high-energy fractures as IIIA even if the skin wound is not large. Grade IIIA fractures include high-energy fractures, as evidenced by severe bone injury (segmental or highly comminuted fractures) and/or large, often contaminated soft-tissue wounds.Grade III open fractures represent the most severe injuries and include three specific subtypes of injuries.Grade II fractures have larger soft-tissue injuries, measuring more than one centimeter.Sometimes it is difficult to assess if a fracture is open (meaning the wound connects to the broken bone), but this can be determined by injecting fluid into the fracture site and seeing if the fluid exits from the wound. A grade I open fracture occurs when there is a skin wound that communicates with the fracture measuring less than one centimeter.
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