title: Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation.
abstract: BACKGROUND
  Segmental fractures of the tibial shaft (AO type 42-C2) often occur after a high energy direct trauma with consecutive severe soft tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed and therefore operative treatment is demanding. In this retrospective study, we compared three different methods of stabilisation.
  
  
  METHODS
  We reviewed the clinical charts and postoperative problems of 26 patients in a ten year period. Sixteen (62%) fractures were stabilised with an intramedullary nail, five (19%) fractures by plate osteosynthesis and five (19%) fractures with an external fixator.
  
  
  RESULTS
  Bony consolidation was obtained in all patients after an average time of 11.4 months. In 17 patients (65.4%) a second operative procedure had to be performed. Pseudarthrosis was seen in 11 fractures (40%), three times in the proximal and eight times in the distal fracture. In the intramedullary nailing group, pseudarthrosis occurred in nine patients. In the group treated with an external fixator, pseudarthrosis was seen three times. After changing to a different implant bony consolidation was achieved in every patient.
  
  
  CONCLUSIONS
  Conventional intramedullary nailing is not suitable for stabilisation of segmental fracture types with a short metaphyseal fracture fragment. New nails with proximal and distal interlocking in three different planes offer better stability. Bone vascularisation should not be endangered by the stabilisation procedure and optimal reduction of the fracture is an important prerequisite for uneventful fracture healing, especially in this difficult fracture configuration.
authors.affiliation: Department of Trauma Surgery, University Hospitals of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, Germany. beardi@gmx.de
authors.forename: J
authors.initials: J
authors.lastname: Beardi
authors.forename: M
authors.initials: M
authors.lastname: Hessmann
authors.forename: M
authors.initials: M
authors.lastname: Hansen
authors.forename: P M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D015331:Cohort Studies; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome