A 25-year-old male patient sustains an open tibial shaft fracture after a high-speed motor-vehicle collision. He is treated initially with serial irrigation and debridement, which leaves the tibia with a clean 4-cm midshaft cortical defect with good soft- tissue coverage. Definitive management should include open reduction and internal fixation with:
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- Placement of bone morphogenetic protein (BMP) into the defect The clinical application of bone morphogenetic protein (BMP) in a 4-cm cortical defect is limited
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- Acute shortening Acute shortening should not be performed for defects of >3 cm
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- Platelet-rich plasma (PRP) in the defect Platelet-rich plasma (PRP) has not been shown to have a definitive effect on bone healing
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- Placement of autologous bone graft into the defect Autologous bone graft is a good option for bone loss of 4 cm