The management of open tibial shaft fractures

A 28 year old cyclist was hit by a car in a road traffic incident. It was a side on collision, and his left leg was caught between a bollard and the bumper of the car. The saloon car had been travelling at 30 miles per hour (48 km/h). The cyclist’s left leg had been trapped for 10 minutes before being freed. He had no medical history, was taking no drugs, and had no allergies.

On arrival at the emergency department, he was managed according to the advanced trauma life support protocol with a primary survey. His cervical spine was immobilised, his airway was clear, breathing was normal with saturations of 100%, and he was haemodynamically stable, with a Glasgow coma scale of 15 out of 15. He had an 11 cm wound over the anterior part of the left lower leg with an open tibia fracture (fig 1⇓). He was neurovascularly intact with a capillary refill of less than 2 seconds. A trauma series was ordered with additional radiographs for the affected limb.