title: Segmental tibial fractures: an infrequent but demanding injury.
abstract: BACKGROUND
  Segmental tibial fractures are considered to be a special injury type associated with high complication rates. However, it is unclear whether healing of these fractures truly differs from that of nonsegmental fractures.
  
  
  OBJECTIVE
  We therefore asked (1) does the time to union in segmental tibial fractures differ from that of nonsegmental fractures; and (2) does the complication rate of segmental fractures differ from that of nonsegmental fractures?
  
  
  METHODS
  We retrospectively studied 30 patients with segmental tibial fractures treated at a Level I trauma center from January 2000 to December 2008 and compared healing and complications with a matched control group of 30 nonsegmental tibial fractures. In followup we determined time to union, delayed and nonunion, and overall complication rates. Patients were followed at least until union was attained. The minimum followup was 5 months (median, 15 months; range, 5-54 months).
  
  
  RESULTS
  Median time to union was 34 weeks (range, 12-122 weeks). Segmental fractures took longer to heal than nonsegmental fractures (median, 34 weeks; range, 12-122 weeks and median, 24 weeks; range, 11-39 weeks, respectively). The overall rate of complications was higher in segmental fractures as was the necessity for reoperation to attain healing.
  
  
  CONCLUSIONS
  Healing of segmental tibial fractures is characterized by substantially more complications and longer healing times than nonsegmental fractures and should be considered as a special type of injury. We believe these should be treated in specialized trauma centers.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, PO Box 85500, Suite G04.228, 3508 GA, Utrecht, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Teraa
authors.forename: Taco J
authors.initials: TJ
authors.lastname: Blokhuis
authors.forename: Lisa
authors.initials: L
authors.lastname: Tang
authors.forename: Loek P H
authors.initials: LP
authors.lastname: Leenen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017102:Fracture Healing; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome