title: Surgical treatment of tibial shaft fracture: experience of 207 cases.
abstract: From January 1984 to March 1988, 210 tibial shaft fractures in 207 patients treated by intramedullary nails, and by plate and screws and extraskeletal fixation were studied. There were 166 men and 41 women. Of the fractures, 95 (42.2%) of the 210 tibial shaft fractures were closed fractures and 115 (54.8%) were open fractures [Grade I: 44 (21.0%), Grade II: 39 (18.6%), and Grade III: 32 (15.2%)]. The incidence of associated injury was 44.3% and it was highest in the group with extraskeletal fixation (64.7%). Intramedullary nailing was performed in the majority of these fractures (127 out of 210) and yielded the best results in this series. Kuntscher's nailing resulted in nonunion in 3 cases (2.8%), superficial infections in 3 cases (2.8%) and deep infections in 4 cases (3.8%). Interlocking nailing resulted in nonunion in 1 case (4.8%), superficial infection in 1 case (4.8%) and deep infections in 3 cases (14.3%). Plate and screws fixation was performed primarily for metaphyseal fractures (71.4%) and resulted in nonunion in 4 cases (8.1%), superficial infection in 1 case (2.0%) and deep infection in 5 (10.2%). In the group treated with extraskeletal fixation, inasmuch as there were more cases of compromised soft tissue (open fracture, 97.1%), a higher incidence of associated major injuries (64.7%) and more cases of comminution of the bone (67.6%), the final results were less satisfactory. Nonunion was noted in 26.5% of the cases, superficial infection in 2.9% of the cases, and deep infection in 32.4% of the cases. From our study, we conclude that in appropriately selected patients, surgical fixation of tibial shaft fractures can produce a good functional recovery with an acceptable low rate of complications.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, National Taiwan University Hospital, Taipei, R.O.C.
authors.forename: J S
authors.initials: JS
authors.lastname: Sun
authors.forename: S M
authors.initials: SM
authors.lastname: Hou
authors.forename: Y S
authors.initials: YS
authors.lastname: Hang
authors.forename: T K
authors.initials: TK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013978:Tibial Fractures / Q000601:surgery*