Open tibial fractures Part 1 : a narrative review of initial treatment and potential applicability to the Southern African context

Abstract

Treatment guidelines for open tibial fractures are well established in high-income countries, but their implementation in low-resource settings remains challenging. To date, only one African country has attempted to formulate national, consensus-based guidelines that cover key aspects such as antibiotic administration, initial stabilization, surgical debridement, wound management, and definitive fixation. This narrative review summarizes current principles for the initial management of open tibial shaft fractures and evaluates their relevance in the Southern African context, particularly in rural and resource-constrained environments. Given the limited availability of advanced imaging, specialized implants, and soft-tissue coverage expertise, clinicians must adapt existing protocols to local capacities. This review highlights areas where treatment recommendations from high-income settings may not be feasible and identifies practical considerations for applying initial management principles in Southern Africa. The need for context-specific, resource-appropriate guidelines is emphasized.