Management of a III-b tibia fracture is best treated initially by:

D. External fixation.

DISCUSSION: Studies by Hansen and others have demonstrated that open reduction and internal fixation of Grade III-b or Grade III-c fractures are likely to cause more stripping of soft tissue and therefore further devascularize an already devascularized tibia. The external fixator is selected because it is a treatment apparatus that reduces and holds the bone fragments and provides important stability for soft tissue healing. Treatment of open wounds with a plaster cast is impractical and wound care is difficult. Reaming intramedullary nailing further compromises blood supply to the bone by destroying the intramedullary blood supply that may be critical to fracture healing.