Perils and pitfalls of open tibial fractures.

The status of the fibula is an index of the severity of injury. Open tibial fracture with associated fractured fibula is more likely to develop complications. Antibiotics should be started promptly. Judicious debridement is essential but bone fragments should be left whenever possible. When there is any question about contamination, the wound is best left open. Rigid occlusive dressings promote epithelial ingrowth. Fracture distraction and plate fixation are associated with a high incidence of complications.