title: Dilemmas in the treatment of tibial diaphyseal fractures.
abstract: BACKGROUND
  Tibial fractures accompanied by radius fractures at typical sites are the most common type of fractures.
  
  
  OBJECTIVE
  The study is aimed at using the examined sample to make an efficient and economically acceptable choice in the treatment of tibial diaphyseal fractures.
  
  
  METHODS
  The series comprises a retrospective and prospective study of the treatment of 131 fresh tibial fractures: 31 in women (23.66%) and 100 in men (76.34%) of the average age of 37.89. Nineteen patients (14.50%) were treated conservatively and 112 (85.50%) surgically: 22 (16.79%) with anti-rotation intramedullary nails, 74 (56.49%) with Mitkovic external fixator type M20, and 16 (12.21%) with locking compression plate. General anaesthesia was used in 46 patients (35.11%), while spinal anaesthesia was used in 85 of them (64.89%).
  
  
  RESULTS
  According to the Karlstrom-Olerud scoring system, the treatment results were as follows: for the 22 tibiae treated with anti-rotation intramedullary nails: in 15 (68.18%) the results were excellent, in 3 (13.64%) they were good and in 4 (18.18%) they were poor. As for the results for the 74 tibiae treated with Mitkovic external fixator type M20, they were as follows: in 62 (83.78%) excellent, in 9 (12.16%) good, and in 3 (4.05%) they were poor. The results for the 16 patients treated with locking compression plate were excellent in 10 (62.50%), good in 2 (12.50%) and poor in 4 patients (25.00%). The treatment results for the 19 tibiae treated with plaster cast were excellent in 12 patients (63.16%), good in 2 (10.53%) and poor in 5 (26.32%). The definite results for the 131 fractured tibiae treated with the aforementioned techniques were as follows: excellent in 99 (75.57%), good in 17 (12.98%) and poor in 15 patients (11.45%).
  
  
  CONCLUSIONS
  There is a variety of controversial positions concerning the treatment of the tibial diaphysis.
  
  
  CONCLUSIONS
  On the basis of the results of surgical treatment for the given series, the number of surgical interventions, the price of osteosynthetic material, my preferences in treating tibial diaphyseal fractures would be as follows: Mitkovic external fixator type M20, anti-rotation intramedullary nails and locking compression plate. Conservative treatment is indicated when the X-ray examination confirms that the fragments have a position acceptable for conservative treatment with plaster cast.
authors.affiliation: Traumatology Clinic, Clinical Centre Banja Luka.
authors.forename: Predrag
authors.initials: P
authors.lastname: Grubor
authors.forename: Milan
authors.initials: M
authors.lastname: Grubor
authors.forename: Rade
authors.initials: R
authors.lastname: Tanjga
authors.forename: Milan M
authors.initials: MM
authors.lastname: Mitković
mesh_terms: D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D002370:Casts, Surgical; D018483:Diaphyses / Q000293:injuries; D016267:External Fixators; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult