The principles of the treatment of tibial shaft fractures: a review of 10,146 cases from the literature.
The tibial shaft is a common site of long bone fracture, and both nonoperative and operative treatment methods have been developed in an effort to speed union while minimizing complications. To compare the recent results of present treatment alternatives and to identify those factors of prognostic significance, a review of the 1976-1981 English literature was performed, representing a review of 10, 146 fractures. Comminution, displacement, bone loss, distraction, soft tissue injury, infection, polytrauma, and patient personality were found to be factors that place the patient with a tibial shaft fracture at risk for local and systemic complications. Fracture location, fracture configuration, and concomitant fibula fracture were found to be of no prognostic significance. The advantages and disadvantages of casts, traction, plates, intramedullary rods, and external fixation are discussed. The principles of treatment of soft tissue injury, transverse and short oblique fractures, spiral fractures, single butterfly comminution, segmental fractures, comminuted fractures, bone loss, "floating knee" injuries, bilateral tibial fractures, and brain injured patients are detailed.
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Keller