A 30-year-old motorcyclist has a type IIIB open tibial shaft fracture with 8 cm of periosteal stripping. After debridement, which is the preferred method of definitive skeletal stabilisation?
- A Plaster of Paris cast immobilisation
- B Intramedullary nailing (IMN) with reamed nail
- C External fixation as a bridge to later definitive fixation or IMN ✓
- D Dynamic compression plating through the wound
Correct answer: C. External fixation as a bridge to later definitive fixation or IMN
Explanation
In Gustilo IIIB open tibial fractures with significant soft tissue loss, external fixation is the initial skeletal stabilisation of choice because it avoids implant placement in a contaminated wound bed and maintains alignment while soft tissue reconstruction (flap coverage) is achieved. After wound coverage is secured, conversion to reamed IMN is considered within 2–4 weeks. Immediate unreamed IMN may be used in selected IIIB cases by experienced centres but carries infection risk. Plating through open wounds and cast immobilisation are contraindicated.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.