Open Tibial Fractures; The tibia (shinbone) is a subcutaneous bone, meaning that there is little fat between the bone and skin; therefore, tibia fractures are often open. Meaning, the bone breaks and punctures through the skin. Tibia fractures are a medical emergency because the injury causes the patient to be more susceptible to systemic infections and can delay bone healing! The treatment goal is to save the life of the patient and the limb, mend the fracture, and prevent infections. Although this is a severe injury, a speedy recovery is possible.

On August 1, 2014, Indiana Pacers All-Star Paul George suffered an open fracture of the tibia and fibula bones in his lower right leg during an intrasquad scrimmage of the USA Men’s Basketball team. His injury occurred after he slammed into the basketball stanchion while trying to defend a fastbreak. The same evening, he had a successful surgery and was on the road to recovery. Eight months later, he returned to play in his first NBA game against the Miami Heat.


● Motor vehicle accidents (MVA)
● Skiing accidents
● Sports injuries (football, soccer, rugby, bicyclist hit by a car)
● High-level falls


● Medical Emergency! Call 911, immediately!
● The injured person will be prepped for surgery.
● Preoperative blood tests will be performed.
● Routine limb, chest, and cervical (neck) X-rays will be ordered.
● Antibiotic therapy will be given to prevent infection.
● Wound irrigation and debridement will begin.
● Surgical repair (external fixation) and possible amputation will begin after wound irrigation.


● High energy tibial fractures have a high frequency of compartment syndrome.
o Signs and symptoms of compartment syndrome are pain and loss of sensation in the affected extremity.
● Blood clots may develop.
● Increased rate of nonunion, infection, and chronic pain syndrome are possible.
● Osteomyelitis can occur months or years later after the injury.
● Pin-site infections are common with external fixation treatments.
● Chronic osteomyelitis in the pin sites is also common.


❖ Management begins with through patient evaluation including assessment of the bone and soft tissue surrounding the tibial injury.

❖ A close follow-up with the orthopedic specialist and primary care physician is necessary for monitoring chronic pain syndrome (CPS) since CPS is expected and needs to be treated early.

❖ Patients, orthopedic specialists, and primary care physicians should also watch for acute, subacute, or chronic osteomyelitis to occur months or even years after the injury.

Figure 1: Right tibial fracture with internal fixation hardware


Chiari, M. (2015). Paul George Injury: Updates on Pacers Star’s Recovery from Leg Surgery.

Creative Endeavors. (2022). [X-ray]. Right tibial fracture with internal fixation hardware.

Melvin, S.J.; Dombroski, D.G.; Torbert, J.T.; Kovach, S.J.; Esterhai, J.L; & Mehta, S. (2010). Open Tibial
Shaft Fractures: I. Evaluation and Initial Wound Management.

Patel, M. (2022). Open Tibia Fractures.

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