Clinical Study of Tibial Shaft Fractures

Kim, Soo Kil; Rhee, Keung Bae; Oh, Sae Jung; Yang, Kye Seok

Abstract

The tibia has poor soft tissue coverage and poor blood supply in anatomy, but it is the most commonly fractured bone of all the long bones, therefore tibial fractures are much controversy concerning the method of treatment because of frequent complications. The 63 adult patients(67 fractures) with fractures of the shaft of the tibia were treated at the Department of Orthopaedic Surgery, Choong Ang Gil Hospital during the 4 years from Jan. 1984 to Dec. 1987. by the group, the 24 cases(25 fractures) were treated with conservative methods, the 21 cases(23 fractures) were treated with self compression plate & screw fixation and the 18 cases(19 fractures) were treated with Ender nailing. The results obtained were as follows; 1. The average time of bone union was the 17.7 weeks.;the 14.1 weeks in the Ender nailing, the 17.5 weeks in conservative treatment methods, the 21.2 weeks in the compression plate & screws fixation. While hte rate of bone union was the 91.0%.;the 96.0% in conservative treatment method, the 86.9% in the compression plate & srews fixation, the 89.5 in the Ender nailing. 2. In the average time of bone union among the various levels of fractures, middle one third(16.7 weeks) healed more rapidly than the proximal one third(18.4 weeks) and distal one third(18.3 weeks). 3. As to the types and natures of fracture, average time of bone union was longer in open fractures(19.9 weeks) and comminuted fractures(20.6 weeks) than closed fractures(17.0 weeks) and simple fractures(15.5 weeks). 4. By the modified Ellis classification of tibial fractures, average time of bone union was the 16.2 weeks in minor severity, the 18.3 weeks in moderate severity, and the 20.1 weeks in major severity. Therefore the higher the severity, the longer the average time of bone union and the higher the complication. 5. In an intact fibula, tibial fractures healed more rapidly and the complications ocurred in the concomitant fibular fractures. 6. The complication of the tibial fractures were 28 cases, and most important complication were impairment of joint function, malunion and common peroneal nerve injury in conservative method, nonunion and infection in the compression plate and screws fixation, and delayed union in the Ender nailing.