Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades

Objectives: To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo–Anderson (GA) open fracture classification. Data Sources: PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018. Study Selection: One hundred sixty-one articles meeting the following inclusion criteria: English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected. Data Extraction: All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures. Data Synthesis: Due to variability in the data reviewed, statistical evaluation could not be reliably done. Results: 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977–1986, 16.2% for 1987–1996, 20.5% for 1997%–2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977–1986, 17% for 1987–1996, 12.8% for 1997%–2006%, and 12.3% for 2007–2017. Conclusions: This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.