Changing patterns in tibial fractures resulting from skiing

Of the 734 adult tibial fractures treated in Aspen, Colorado, from 1968-1978, follow-up results were obtained on 527 (72%). The fractures were analyzed with regard to rate of healing, age of patient, and location of fractures. There was a statistically significant increase in healing time with increasing age between ages 16-40. The location of tibial fracture (proximal, middle, distal) had no significant influence on rate of healing. The occurrence of open tibial fracture was low (3% of total) and in most instances wounds were benign (Class I). Compartment syndrome is rarely encountered in skiing fracture because of the relatively low energy involved. All tibial fractures occurring between 1982-1984 were reviewed and compared to the earlier series. This comparison confirmed the continual overall decline in rate of tibial fracture from skiing (from 12.9/100,000 skier days in 1968 to 2.9/100,000 skier days in 1983). This decline was primarily in spiral fractures (from 70% of total in 1968 to 50% in 1983). The percent of transverse fractures was unchanged (+/- 15%) while the percent of short oblique fractures increased from 11% to 33%. Properly adjusted and maintained safety equipment afforded reasonable protection from spiral fractures of the tibia, but a conceptual departure from the current release binding design would be required to protect against the benign moments that produced transverse and short oblique fracture. The current treatment philosophy is based on fracture type and the availability or experience with newer treatment modes.