A series of tibial fractures treated conservatively

Two hundred and two fractures of the tibia have been reviewed. They were treated by a standard, conservative method; with a Phemister graft when union was delayed and a pseudarthrosis threatened. The classifications of Charnley (1968) and Nicoll (1964) have proved to be useful in assessing results and these complement each other. The factors that influence bony union include damage to the interosseous membrane, the degree of the displacement and comminution of the fracture, and injury to soft tissues. Infection has a very unfavourable influence on bone union and leads to the majority of bad sequelae. The fundamental object in reduction is to obtain as perfect apposition and alignment of the fragments as possible. Imperfect apposition, however, with normal alignment does not affect bone union severely. The problem arising from the use of an above-knee walking plaster that affects the patient physically, psychologically and socially, may be solved by the early use of a below-knee plaster. The functional sequelae are the result of soft-tissue damage rather than of immobilization. The Chutro-Phemister type of graft has proved to be a safe method in preventing pseudarthrosis. The analysis of the results obtained with this conservative method is sufficient reason against choosing surgical treatment for these fractures.