[Fracture of the tibial shaft--still a traumatology problem?]

Diaphyseal fractures of the lower leg have continued to hold a special position in terms of incidence, type, severity, and frequency of typical complications as well as healing disorders. Despite general consensus regarding fracture healing and major factors of influence, there still is discrepancy of opinions and recommendations, in the context of pathophysiology, mechanics, and therapy. All in all, 302 fresh fractures and 134 cases of delayed healing or pseudoarthrosis in the diaphyseal region were treated, between 1971 and 1985. It has been the authors' experience that conservative treatment, according to the classical school, should be applied whenever possible. The trend in surgery, primarily for open fractures, is towards adequately dimensioned fixateur externe. Accurately defined minimum instability and healing with callus formation are nowadays appreciated and preferred. The fibula-ligament-membrane-complex may assume great importance to instable or defective forms of tibial fractures. Experimental and clinical investigations are likely to suggest that, depending on the individual case, the fibula should be included in the overall therapeutic concept, when it comes to impaired or delayed healing and pseudoarthrosis.