Closed reduction of tibial shaft fractures using a sling

We wish to report a simple technique for closed reduction of tibial shaft fractures. The patient is put in the supine position. Longitudinal traction is applied through a plaster boot on the corresponding foot and ankle. A gauze sling (Fig. 1) placed behind the calf at the fracture site allows suspension of the limb whilst controlling posterior angulation and displacement. This allows control of the limb whilst alignment is checked with the image intensifier in two planes. When satisfactory reduction is obtained, a long leg plaster can be applied to immobilize the fracture. The technique was applied to 21 closed tibial shaft fractures in 21 patients. Satisfactory results were obtained in 20 patients. Analysis of the initial post-manipulation X-rays showed an average of 5.2 mm shortening (range 0-15 mm). The average coronal angulation was 1.9 degrees (range 0-5 degrees), and sagittal angulation was 2.0 degrees (range 0-8 degrees). Average percentage overlap of the fracture fragments was 79% in the coronal plane (range 40-100%) and 82% in the saggital plane (range 50-100%). We found this technique to be simple and reliable. It is particularly useful as the first phase of non-operative treatment of tibial shaft fractures by functional bracing.