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Trauma: S. B. Naique, M. Pearse, and J. Nanchahal Management of severe open tibial fractures: THE NEED FOR COMBINED ORTHOPAEDIC AND PLASTIC SURGICAL TREATMENT IN SPECIALIST CENTRES J Bone Joint Surg Br 2006; 88-B: 351-357 [Abstract] [Full text] [PDF]

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Management of severe open tibial fractures

Andy McMurtrie, Steve Sarasin, Harish Kurup, Ashok K. Sinha.   (13 April 2006)

Management of severe open tibial fractures 13 April 2006
Andy McMurtrie, Specialist Registrar in Orthopaedics Ysbyty Gwynedd, Bangor, Steve Sarasin, Harish Kurup, Ashok K. Sinha. Send letter to journal: Re: Management of severe open tibial fractures ajmac{at}tesco.net Andy McMurtrie, et al.	Sir, We read this article with interest. We feel that the article raised several important issues. Firstly, there did not appear to be any comment on the timing of skin cover from initial fixation. This has been suggested to be critical by Giannoudis et al,1 and appears to have been omitted in your study. Their work suggests that patients in whom cover is obtained within 72 hours have a better outcome. Secondly, we feel that should the suggestions in this paper be followed, tertiary referral centres would be inundated with referrals from district general hospitals (DGH) and most probably be unable to provide skin cover within the recommended 72-hour period. Finally, we note that the actual limb function outcome showed no difference between the groups, and so surely one can equally conclude that primary initial stabilisation in a DGH with adequate debridement is acceptable management, providing referral to a tertiary centre and subsequent skin cover occurs within 72 hours. We would value the authors' comments. A. McMurtrie, Specialist Registrar in Orthopaedics, S. Sarasin, H. Kurup, A.K. Sinha, Bangor, Wales, UK. 1. Gopal S, Giannoudis P V, Murray A, Matthews S J, Smith R M. The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage. J Bone Joint Surg [Br] 2004;86-B:861-7.