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The segmental tibial fracture.

T S Woll1, P J Duwelius

  • 1Oregon Health Sciences University, Division of Orthopedics and Rehabilitation, Portland 97201.

Clinical Orthopaedics and Related Research
|August 1, 1992
PubMed
Summary

Segmental tibial fractures often result from severe trauma and lead to high complication rates. Intramedullary nailing appears to be the safest treatment option, minimizing complications.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Care
  • Reconstructive Surgery

Background:

  • Segmental tibial fractures are complex injuries, frequently associated with high-energy trauma.
  • A significant proportion of these fractures are open, increasing infection risk and treatment complexity.

Purpose of the Study:

  • To report outcomes and complications of treating 31 segmental tibial fractures.
  • To evaluate different treatment modalities and identify factors influencing outcomes.

Main Methods:

  • Retrospective case series of 31 patients with segmental tibial fractures.
  • Review of treatments including external fixators, intramedullary nails, casts, and amputations.
  • Analysis of complication rates, focusing on compartment syndrome, infection, nonunion, and malunion.

Main Results:

  • Eighty-four percent of patients had multiple trauma, with 80% of these being open fractures.
  • High complication rates observed: 48% compartment syndrome, 19% residual neurological deficits, 35% infection/nonunion/malunion.
  • Distal fracture sites accounted for 81% of delayed or nonunions.
  • Intramedullary nailing resulted in fewer complications compared to other methods.

Conclusions:

  • Segmental tibial fractures carry a high risk of serious complications, including compartment syndrome and nonunion.
  • Close monitoring for elevated compartment pressures is crucial.
  • Prompt decompression, fracture stabilization, and consideration of intramedullary rods without reaming are recommended treatment strategies.

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