Open Tibial Fractures Research Articles

Definitive fixation of open tibia fractures: Does reopening the traumatic wound increase complication rates?

BackgroundIt is unknown if surgical approach or use of previous traumatic wounds for open fracture instrumentation has an impact on patient complications or outcomes. This study sought to compare infection and nonunion rates in the staged treatment of open tibia fractures where the traumatic wound was reopened during definitive fixation versus when they were not. MethodsA retrospective review was performed on all patients at a single institution level 1 trauma center. All patients who had a minimum of 1 year clinical and radiographic outcomes were included. Primary outcome measures were incidence of infection and nonunion. Groups of patients were compared based on surgical approach for definitive fixation. ResultsA total of 96 patients were included – 48 patients received definitive treatment and wound closure during initial management of the open fracture (group 1), 22 patients had staged fixation through new incisions (group 2), and 26 patients had their traumatic wound reopened during definitive fixation (group 3). Rates of infection were 10.4%, 31.8% and 11.5% respectively (p = 0.15). Rates of nonunion were 20.8%, 27.3% and 30.8% (p = 1.0). No statistically significant differences in regards to primary outcomes were found between the staged fixation groups. Multiple logistic regression also showed no difference in infection or nonunion when controlling for known risk factors. ConclusionFor open tibia fractures that underwent staged fixation, no significant differences in infection or nonunion were observed between procedures that involved reopening the traumatic wound versus procedures performed through new incisions. The presence of a distal tibia periarticular fracture was found to be independently associated with infection risk.

AO external fixator for definitive treatment of an open distal tibia fracture during the COVID-19 pandemic

BackgroundThe accepted gold standard for primary treatment of long bone open fractures consists of aggressive debridement, irrigation and temporary external fixation. Removal of the external fixator followed by definite internal fixation is recommended within the first two weeks after the injury to obtain a more stable fixation, alleviate rehabilitation and to avoid pin infection. Materials & MethodsHere, we report a case of a Gustilo IIIB open tibia fracture with extended soft tissue degloving of the distal tibia. Following removal of the AO external fixator, plate fixation and soft tissue coverage with a free flap, implant loosening occurred warranting a return to external fixation. The patient did not return for follow-up due to a prolonged COVID-19-quarantine and no further treatment was installed. Results & ConclusionsThe patient returned after 6 months with the fractures and soft tissues fully healed. In specific situations, the external fixator may be used as a definitive form of treatment.

What Is Important to Patients Who Are Recovering From an Open Tibial Fracture? A Qualitative Study.

Open tibial fracture research has traditionally focused on surgical techniques; however, despite technological advances, outcomes from these injuries remain poor, with patients facing a sustained reduced quality of life. Research has rarely asked patients what is important to them after an open tibial fracture, and this question could potentially offer great insight into how to support patients. A qualitative study may assist in our understanding of this subject. We asked: (1) What common themes did patients who have experienced open tibial fractures share? (2) What stresses and coping strategies did those patients articulate? (3) What sources for acquiring coping strategies did patients say they benefited from? Semistructured interviews were conducted with patients who had sustained an open tibial fracture between January 1, 2016 and January 1, 2019. All participants were recruited from a Level 1 trauma center in England, and 26 participants were included. The mean age was 44 ± 17 years, and 77% (20 of 26) were men. The patients' injuries ranged in severity, and they had a range of treatments and complications. Transcripts were analyzed using framework analysis, with codes subsequently organized into themes and subthemes. Four themes were identified, which included recouping physical mobility, values around treatment, fears about poor recovery, and coping strategies to reduce psychological burden. Coping strategies were important in mitigating the psychological burden of injury. Task-focused coping strategies were preferred by patients and perceived as taking a proactive approach to recovery. Healthcare practitioners, and others with lived experience were able to educate patients on coping, but such resources were scant and therefore probably less accessible to those with the greatest need. Most individuals fail to return to previous activities, and it is unlikely that improvements in surgical techniques will make major improvements in patient outcomes in the near future. Investment in psychosocial support could potentially improve patient experience and outcomes. Digital information platforms and group rehabilitation clinics were identified as potential avenues for development that could offer individuals better psychosocial support with minimal additional burden for surgeons. Level IV, therapeutic study.

Differential hippocampal protein expression between normal mice and mice with the perioperative neurocognitive disorder: a proteomic analysis

ObjectivesTo compare differential expression protein in hippocampal tissues from mice of perioperative neurocognitive disorder (PND) and normal control mice and to explore the possible mechanism of PND.MethodsMice were randomly divided into a PND group (n = 9) and a control group (n = 9).The mice in the PND group were treated with open tibial fracture with intramedullary fixation under isoflurane anesthesia, while the mice in the control group received pure oxygen without surgery. The cognitive functions of the two groups were examined using Morris water maze experiment, Open field test and Fear conditioning test. The protein expression of the hippocampus of mice was analyzed by high-performance liquid chromatography–mass spectrometry (HPLC–MS/MS). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to explore the principal functions of dysregulated proteins.ResultsA total of 21 proteins were differentially expressed between PND and control mice on days 1, 3, and 7 after the operation. These proteins were involved in many pathological processes, such as neuroinflammatory responses, mitochondrial oxidative stress, impaired synaptic plasticity, and neuronal cell apoptosis. Also, the dysregulated proteins were involved in MAPK, AMPK, and ErbB signaling pathways.ConclusionThe occurrence of PND could be attributed to multiple mechanisms.

Commentary on: "Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis".

Commentary on: "Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis".

In Reply to Commentary on: "Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis".

In Reply to Commentary on: "Definitive Fixation Outcomes of Open Tibial Shaft Fractures: Systematic Review and Network Meta-analysis".

Application of individualized controllable stress external fixation in open tibial fractures

To study the clinical effect of individualized controllable stress external fixator in the treatment of open tibial fractures. From December 2018 to July 2020, 60 patients with open tibial fractures were treated, including 35 males and 25 females;The age ranged from 23 to 58 years;The course of disease was 1.2 to 10.0 h. According to the stress stimulation on the fracture end after operation, all patients were divided into 4 groups, including non stress group (15 cases) and 3 groups with different stress stimulation(15 cases in each group). All patients with open tibial fractures were treated with controllable stress external fixator. Four weeks after operation, the stress group adjusted the elastic external fixator to apply axial stress of 1/6, 2/6 and 3/6 of their own weight to the fracture end based on the patient's weight. The wound healing of all patients after operation was observed, the plain CT images of fracture ends at 4, 6, 8, 10 and 12 weeks after operation were followed up, the average valueof callus area per 10 scanning planes was calculated, and the differences between the groups were compared. The fracture healing was observed and statistically analyzed. The wounds of all patients healed well, of which 7 patients underwent secondary free skin grafting and transferred myocutaneous flap. All patients were followed up for 12 to 24 months, with an average of 16.5 months. The final follow-up results showed that the fracture healing of stress groups and non stress group had significant difference(P<0.05). After axial stress stimulation at the fracture end, CT examination was performed on the fracture end of all patients at 4, 6, 8, 10 and 12 weeks. The average values of callus area in 10 plain scanning planes were calculated as follows:no stress group (0.275±0.092) mm2, (0.383±0.051) mm2, (0.412±0.048) mm2, (0.472± 0.019) mm2, (0.548±0.036) mm2, the area of callus growth in the stress group was significantly higher than that in the non stress group. There was significant difference among these groups(P<0.05). When the controllable stress external fixation technique is used to treat open tibial fractures, the elastic external fixator is adjusted according to the patient's own weight after 4 weeks, and a certain axial stress is applied to the fracture end, which is conducive to the fracture healing of patients, and can reduce the incidence of delayed union or nonunion of open fractures, which has a certain application value.

Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines

Background: Road traffic injury (RTI) is the largest cause of death amongst 15–39-year-old people worldwide, and the burden of injuries such as open tibia fractures are rapidly increasing in Malawi. This study aims to investigate disability and economic outcomes of people with open tibia fractures in Malawi and improve these with locally delivered implementation of open fracture guidelines. Methods: This is a prospective cohort study describing function, quality of life and economic burden of open tibia fractures in Malawi. In total, 160 participants will be recruited across six centres and will be followed-up with face-to-face interviews at six weeks, three months, six months and one year following injury. The primary outcome will be function at one year measured by the short musculoskeletal functional assessment (SMFA) score. Secondary outcomes will include quality of life measured by EuroQol EQ-5D-3L, catastrophic loss of income and implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) at one year. A nested pilot pre-post implementation study of an interventional bundle for all open fractures will be developed based on other implementation studies from low- and middle-income countries (LMICs). Regression analysis will be used to model and investigate associations between SMFA score and fracture severity, infection and the pre- and post-training course period. Outcome: This prospective cohort study will report patient reported outcomes from open tibia fractures in low-resource settings. Subsequent detailed evaluation of both the clinical and implementation components of the study will promote sustainability of improved open fractures management in the study sites and further scale-up of open fracture management guidelines. Ethics: Ethics approval has been obtained from the Liverpool School of Tropical Medicine and College of Medicine Research and Ethics committee.

1445 Using BOAST Guidelines to Boost Standards: An Audit of Adherence to BOAST Open Fracture Guidelines

Abstract Aim Open fractures require prompt management and appropriate infrastructure is required to deliver optimal care. The BOAST Open Fracture guidelines (2017) set out best practice in their management and advocate a combined Orthoplastics approach. Method All patients with open tibial fractures who presented to or were referred to our hospital from January 2018 - March 2020 were included in our audit. The standard used was the BOAST Open Fracture Guidelines. Data was collected retrospectively for cycle one (January – December 2018) then prospectively for cycle two (November 2019 – March 2020). Between cycles, results from cycle one was used to facilitate a business case for the creation of a second scheduled weekly Orthoplastics list in our hospital. Results 61 injuries met inclusion criteria in cycle one and 23 in cycle two. In cycle one, 28% of cases missed the 72-hour soft tissue coverage target, 11% missed the 7-day target. Only 10% of cases had both Orthopaedics and Plastics consultants involved at initial debridement. Following the invention of an additional weekly Orthoplastics list, the percentage of patients missing the 7-day target for soft tissue coverage halved to 5% and the percentage of cases with both Orthopaedics and Plastics consultants involved at initial debridement more than doubled to 26%. Conclusions We advocate multiple weekly Orthoplastics lists to ensure prompt consultant-led management and minimise delays for patients with open fractures. We have demonstrated that audit of current practice is a simple and effective tool to facilitate improvement in guideline compliance.

A clinical study of proximal tibial condyle fracture treated by locking compression plate

AIMS and Objectives of the Study: The aim of the present study was to study the functional outcome and duration of union in proximal tibial fractures treated with Locking Compression Plate.Material and Methods: This study was a prospective study done on 26 consenting cases of proximal tibial fractures admitted to Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapur during October 2013 To August 2015 chosen based on the inclusion and exclusion criteria. Patients were informed about the study in all respects and written informed consent will be obtained. The follow up period was 6 weeks, 3months and 6months. Inclusive Criteria: All Schatzkers classification type I to VI proximal tibial fractures in adults Aged 18 years and above of either sex. Patients willing for treatment and giving informed and written consent. Exclusive Criteria Age group of less than 18 years. Patients not fit for surgery, managed conservatively for other medical reasons. All open fractures of proximal tibia. Patients with pathological proximal tibial fractures other than osteoporosis. Extraarticular fractures of proximal tibia. Sample Size: With an average incidence rate of proximal tibial fractures 1.75% [0.5 – 3%] at 95% confidence interval and + 5 margin of error the sample size is n=26. Hence 26 cases of proximal tibial fractures were included in the study.

LCP as supracutaneous plate vs IMLN tibia for open grade 1 and Ⅱ distal tibial fractures. A comparison study (RCT) on Functional outcome between a conventional method and a Novel technique

Introduction Orthopaedics is an ever evolving branch. Especially for fractures that have controversies in management options, recent advances are being done. Open distal tibial fractures belong to these groups of difficult, yet very common injuries. As the necessity is the mother of invention, for such a common injury a common plate-LCP was used supracutaneously for better biological fixation and shorter duration of surgery. We have compared the results of IMLN nailing vs supracutaneous plating for open distal tibial fractures. Material and methods The patients who had Gustilo and Anderson type 1 and 2 # of distal tibia were enrolled in this study. They were randomized into 2 groups. In one group (IMLN) intramedullary locking nail and in another group Supracutaneous plating was done (SCP). Duration of clicnal and radiological union was calculated. Functional outcome in both groups was measured in AOFSAS score, Knee Society Score (KSS),Lower extremity functional scoring (LEFS) and Ketenjian and Shelton Criteria modified by Yokoyama. Any complications were charted. Results 100 % fracture union was seen in both cases. Intra operative blood loss was 165 ml and was more in IMLN group than SCP group (100) ml. LEFS at 1 year was 90 in SCP group whereas it was 80 in IMLN group. AOFAS score was similar in both groups showing good functional outcome around ankle joint. Knee society score was statistically better in SCP group (82) whereas in IMLN group it was 70. Incidence of infection and surgical duration was similar in both groups.Due to need for removal in some cases duration of stay was more in IMLN. Conclusion Patients in SCP Group had lesser incidence of persistent pain or other chronic symptoms and were happier (better LEFS score, better Yokahama scoring) than their counterparts with interlocking nail. Using locking plate in a supracutaneous mode is a very simple, easy, rapid, reliable and effective method for management of open tibial fractures in adults, especially in terms of patient satisfaction and can be considered as an effective alternative to nailing in selected patients.

FUNCTIONAL OUTCOME OF DISTAL TIBIA FRACTURES MANAGED WITH HYBRID RING FIXATOR

Introduction : distal tibia fractures are amongst the common open fractures encountered in day to day life owing to high energy trauma , the challenge to achieve union is added on due to absence of soft tissue envelope surrounding the bone apart from biological low blood supply Material and methods: this study was done in SRG Hospital and medical college , Jhalawar Rajasthan , comprising of 25 patients with open extra articular distal tibia fractures. Treated by reduction and external xation with ring hybrid xator. Results: The results were based on the objective and subjective parameters as described by Ovadia DN and Beals RK , we had 14 (56%) patients with excellent, 5 (20%) patient with good, 5 (20%) patients with fair and 1 (4%) patient with a poor outcome.

Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines.

Background: Road traffic injury (RTI) is the largest cause of death amongst 15-39-year-old people worldwide, and the burden of injuries such as open tibia fractures are rapidly increasing in Malawi. This study aims to investigate disability and economic outcomes of people with open tibia fractures in Malawi and improve these with locally delivered implementation of open fracture guidelines. Methods: This is a prospective cohort study describing function, quality of life and economic burden of open tibia fractures in Malawi. In total, 160 participants will be recruited across six centres and will be followed-up with face-to-face interviews at six weeks, three months, six months and one year following injury. The primary outcome will be function at one year measured by the short musculoskeletal functional assessment (SMFA) score. Secondary outcomes will include quality of life measured by EuroQol EQ-5D-3L, catastrophic loss of income and implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) at one year. A nested pilot pre-post implementation study of an interventional bundle for all open fractures will be developed based on other implementation studies from low- and middle-income countries (LMICs). Regression analysis will be used to model and investigate associations between SMFA score and fracture severity, infection and the pre- and post-training course period. Outcome: This prospective cohort study will report patient reported outcomes from open tibia fractures in low-resource settings. Subsequent detailed evaluation of both the clinical and implementation components of the study will promote sustainability of improved open fractures management in the study sites and further scale-up of open fracture management guidelines. Ethics: Ethics approval has been obtained from the Liverpool School of Tropical Medicine and College of Medicine Research and Ethics committee.

Three-vessel view debridement of the open tibial fracture: a surgical technique.

Adequate debridement of an open fracture is a key component of successful management. Despite having set debridement principles, there is no structured technique available in the literature to guide the surgeon in achieving this. We therefore present a technical note detailing the structured approach to the debridement of any open tibial fracture. Our unit has developed a novel stepwise technique termed locally as the "three-vessel view". Identifying all three primary vessels of the leg facilitates confirmation of inspection of all lower limb compartments thus minimising the risk of missed devitalised tissue or neglected areas of contamination and the potential for consequent disastrous outcomes as a result of inadequate exposure.

Clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture

ObjectiveThis study was designed for the first time to analyze clinical efficacy of bone transport technology in Chinese older patients with infectious bone nonunion after open tibial fracture.MethodsThis study retrospectively analyzed 220 older patients with infectious bone nonunion after open tibial fracture. There were 110 patients receiving bone transport technology (Group A) and 110 patients receiving membrane induction technique with antibiotic bone cement (Group B).ResultsThere were 164 male patients and 56 female patients, with an age range of 65 to 71 years and an average age of 67 ± 1.3 years. Traffic accident, high-fall injury and crush injury account for 45.5, 27.7 and 26.8%, respectively. Age, gender, histories, causes and fracture location had no significant difference between the two groups (P > 0.05 for all). Operation time in the Group A was significantly shorter than that in the Group B (P < 0.05). Linear and positional alignment (70.9 vs. 57.3), American Knee Society knee function score (167.7 ± 14.9 vs. 123.8 ± 15.7), Baird-Jackson ankle function score (89.9 ± 3.5 vs. 78.4 ± 4.9), bone healing index (43.0 ± 2.0 vs. 44.3 ± 3.0) and clinical recovery (8.2 vs. 4.5) of patients in the Group A were significantly better than those in the Group B (P < 0.05 for all). Wound infection in the Group A (7.3%) was significantly less than that in the Group B (16.4%; P < 0.05). There were neither a neurovascular complication nor a recurrence of infection in the two groups.ConclusionBone transport technology achieved better knee and ankle joint function recovery and superior bone healing and clinical efficacy than membrane induction technique with antibiotic bone cement, suggesting that bone transport technique is worthy of extensive promotion to improve clinical condition of older patients with infectious bone nonunion after open tibial fracture.

Intramedullary nailing versus external fixation for open tibia fractures in Tanzania: a cost analysis.

Objectives:Open tibia fractures pose a clinical and economic burden that is disproportionately borne by low-income countries. A randomized trial conducted by our group showed no difference in infection and nonunion comparing 2 treatments: external fixation (EF) and intramedullary nailing (IMN). Secondary outcomes favored IMN. In the absence of clear clinical superiority, we sought to compare costs between EF and IMN.Design:Secondary cost analysis.Setting:Single institution in Tanzania.Patients/Participants:Adult patients with acute diaphyseal open tibia fractures who participated in a previous randomized controlled trial.Intervention:SIGN IMN versus monoplanar EF.Main Outcome Measurements:Direct costs of initial surgery and hospitalization and subsequent reoperation: implant, instrumentation, medications, disposable supplies, and personnel costs.Indirect costs from lost productivity of patient and caregiver.Societal (total) costs: sum of direct and indirect costs.All costs were reported in 2018 USD.Results:Two hundred eighteen patients were included (110 IMN, 108 EF). From a payer perspective, costs were $365.83 (95% CI: $332.75–405.76) for IMN compared with $331.25 ($301.01–363.14) for EF, whereas from a societal perspective, costs were $2664.59 ($1711.22–3955.25) for IMN and $2560.81 ($1700.54–3715.09) for EF. The largest drivers of cost were reoperation and lost productivity. Accounting for uncertainty in multiple variables, probabilistic sensitivity analysis demonstrated that EF was less costly than IMN from the societal perspective in only 55% of simulations.Conclusions:Intramedullary nail fixation compared with external fixation of open tibia fractures in a resource-constrained setting is not associated with increased cost from a societal perspective.

External fixation versus elastic stable intramedullary nailing in the treatment of open tibial shaft fractures in children

IntroductionExternal fixator (EF) is a popular choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.MethodsPatients aged 5–11 years with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF and ESIN groups. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow-up < 24 months or incomplete medical records were also excluded.ResultsIn all, 55 patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no statistically significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no case of nonunion and malunion in either group. The angulation at the latest follow-up was higher in the EF group than the ESIN group (P < 0.01). The radiological union was faster in the ESIN group (7.0 ± 0.9 weeks) than those in the EF group (9.0 ± 2.2 weeks) (P < 0.01). Limb length discrepancy (LLD) was more in the EF group (12.1 ± 4.4, mm) than in the ESIN group (7.3 ± 4.3, mm) (P < 0.01).ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator. Pin tract infection is the most troublesome complication in the EF group while implant prominence is a nuisance in the ESIN group.

Open tibial fracture with severe soft tissue injury and bone loss managed with ipsilateral fibular transport and its complications: a case report

&lt;p class="abstract"&gt;Massive segmental bone defects of tibia present as a challenging task to manage specially when associated with extensive soft tissue injury. A 30 year old male presented to Paras HMRI hospital, Patna, post road traffic accident with Gustilo Anderson 3B comminuted open tibia shaft fracture and with an external fixator in situ with a grossly inflamed and infected wound. Initially patient was managed with serial wound debridement and skin grafting was done early to obtain adequate soft tissue coverage. The patient then underwent application of Ilizarov external fixator with plan of one level fibular osteotomy for ipsilateral fibular transport. With good outcome of the procedure clinically and radiologically, Ilizarov fixator was removed after time duration of about 1.3 years and limb was immobilized in plaster of Paris (POP) cast which was removed after 8 weeks. Within 1 month of removal of POP cast the patient presented to hospital again with complaints of pain and instability when his leg was run over by his child’s bicycle while playing. Diagnosed as fracture of proximal (transported) fibula he was managed then with locking plates; one of which was used as an internal fixator and the other as external fixator which was outside the body and acted as a support to the operated limb. After about 1 year the external locking plate was removed and patient was able to bear weight on his extremities. Despite various modalities to treat massive tibial gap, fibular transport procedure with Ilizarov external fixator seems to be the most viable option.&lt;/p&gt;

Functional Outcome of Open Tibial Fracture Using Illizarov Apparatus

The better treatment for tibial fractures are very vague and difficult. Since the tibia is covered by soft tissue coverage fixing of plate becomes very difficult as it creates wound complications, mainly in case of severe fractures.In this study of 20 cases of open communited fractures of tibia with the Ilizarov ring fixator hybrid technique was used, it was found that this technique has a major advantages in treatment and management of the tibial fracture.

Outcomes of Patients With Nonunion After Open Tibial Shaft Fractures With or Without Soft Tissue Coverage Procedures.

To evaluate the outcomes of patients who underwent soft tissue flap coverage during treatment of a tibia fracture nonunion. Retrospective analysis on prospectively collected data. Academic medical center. One hundred fifty-seven patients were treated for a fracture nonunion after a tibia fracture over a 15-year period. Sixty-six patients had sustained an open tibial fracture initially and 25 of these patients underwent soft tissue flaps for their open tibia fracture nonunion. Manipulation of soft tissue flaps, either placement or elevation for graft placement in ununited previously open tibial fractures. Bony healing, time to union, ultimate soft tissue status, postoperative complications, and functional outcome scores using the Short Musculoskeletal Functional Assessment (SMFA). This group was compared with a group of open tibial fracture nonunions that did not undergo soft tissue transfer. Bony healing was achieved in 24 of 25 patients (96.0%) who received flaps at a mean time to union of 8.7 ± 3.3 months compared with 39 of 41 patients (95.1%) at a mean 7.5 ± 3.2 months (P > 0.05) in the noncoverage group. Healing rate and time to union did not differ between groups. At latest follow-up, the flap coverage group reported a mean SMFA index of 17.1 compared with an SMFA index of 27.7 for the noncoverage group (P = 0.037). Utilization of soft tissue flaps in the setting of open tibia shaft nonunion repair surgery are associated with a high union rate (>90%). Coverage with or manipulation of soft tissue flaps did not result in improved bony healing rate or time to union compared with those who did not require flaps. However, soft tissue flap coverage was associated with higher functional scores at long-term follow-up. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.