A 42-year-old man with a severely comminuted open tibial fracture (Gustilo IIIB) undergoes emergency debridement. The definitive fracture stabilization method that allows wound access, avoids implant contamination, and maintains length while enabling soft tissue coverage is:
- A Immediate intramedullary nailing
- B Above-knee plaster cast and delayed debridement
- C Spanning external fixator as a bridge followed by definitive nailing after wound healing ✓
- D Primary plate fixation with vacuum-assisted closure
Explanation
For Gustilo IIIB open tibial fractures, the accepted damage control orthopaedics (DCO) strategy is initial spanning external fixation (which stabilizes the fracture, maintains length, and allows wound access) combined with serial debridement and ultimately plastic reconstruction (local or free flap) for soft tissue coverage. Once the wound is definitively covered and the patient is stable, conversion to intramedullary nail is performed — typically within 7–14 days — provided infection has not developed. Immediate nailing into a contaminated wound significantly increases deep infection risk.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.