Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Meta-Anal. Mar 18, 2026; 14(1): 116322
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.116322
Published online Mar 18, 2026. doi: 10.13105/wjma.v14.i1.116322
Early orthoplastic soft-tissue coverage in open tibial fractures reduces infection, nonunion, and amputation
Ebrahem Hesham Hashem Mohamed, Department of General Surgery, James Paget University Hospital NHS Foundation Trust, Great Yarmouth NR31 6LA, Norfolk, United Kingdom
Shabbir Ahmad, Department of General Surgery, Nangarhar University, Jalalabad 260101, Nangarhār, Afghanistan
Author contributions: Mohamed EHH and Ahmad S made substantial and equal contributions to this work in accordance with the International Committee of Medical Journal Editors guidelines. Both authors contributed to the conception and design of the study, literature search, data extraction, analysis, and interpretation of data. They jointly drafted the manuscript, critically revised it for important intellectual content, and approved the final version to be published. Both authors agree to be accountable for all aspects of the work, ensuring the accuracy and integrity of any part of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Shabbir Ahmad, Academic Fellow, Department of General Surgery, Nangarhar University, Kabul-Jalalabad Highway, Daronta (Darunta), Jalalabad 260101, Nan
Received: November 11, 2025
Revised: December 4, 2025
Accepted: December 23, 2025
Published online: March 18, 2026
Processing time: 122 Days and 18.9 Hours
Revised: December 4, 2025
Accepted: December 23, 2025
Published online: March 18, 2026
Processing time: 122 Days and 18.9 Hours
Core Tip
Core Tip: Early orthoplastic management of open tibial fractures remains crucial for reducing complications and preserving limb function. This systematic review synthesizes current evidence comparing early vs delayed soft-tissue coverage in Gustilo-Anderson type IIIB and IIIC fractures. Early flap coverage, ideally within the first week after fixation, markedly decreases deep infection and nonunion rates, improves union and limb salvage, and does not increase flap failure risk. The findings reinforce the importance of coordinated orthoplastic collaboration and timely multidisciplinary care in achieving optimal outcomes for complex lower-limb trauma.