Segmental Tibial Shaft Fractures

Segmental Tibial Fractures: An Infrequent but Demanding Injury

“…This seems to result from the segmental fracture per se and not the associated damage, because the time to union of segmental fractures differed from that of a matched group of nonsegmental fractures. Median time to union of the segmental fractures in our series was 34 weeks, which is consistent with union times of segmental tibial fractures reported in the literature ranging from 15 to 43 weeks (Table 4) [2,4,5,8,9,11,12,[14][15][16][19][20][21]. This widespread variance can possibly be explained by how union was defined in the separate studies.…”

“…Our observations emphasize the relatively long time required for union to occur in cases of segmental tibial fractures as suggested in the available literature [2,4,9,11,15,19]. This seems to result from the segmental fracture per se and not the associated damage, because the time to union of segmental fractures differed from that of a matched group of nonsegmental fractures.…”

Minimal Fixations for Treatment of Closed Segmental Fractures of Tibial Shaft in Adults

“…8,9,11,12 Intramedullary nailing is widely accepted as the treatment of choice for uncomplicated tibia shaft fractures. [13][14][15][16] But there is high rate of bone healing problems after intramedullary nailing of segmental fractures which is explained by the frequent use of the unreamed tibial nail as implant of choice. The small diameter of this nail, the small diameter of the interlocking screws, the parallel insertion of both proximal interlocking bolts and the toggling of the bolts in the interlocking holes of the nail all are responsible for the low intrinsic stability of the construct.…”

“…8,10,11 In addition, those patients not fully respond to our instructions which also a cause of healing problems. Many authors stated that union may be delayed in some cases and could be affect either proximal 21 or distal fracture sites, 16 but other authors report no difference in union rates. 22 In our study-delayed union occur in two (10%) patients who affect the distal fracture sites in both patients but it progress to union and take 26-28 weeks to unite without any surgical interference.…”

Treatment of Segmental Tibial Fractures With Supercutaneous Plating

“…[1][2][3] These fractures are usually the result of high-energy trauma and are often associated with significant morbidity caused by severe soft tissue injury, nonunion, delayed union, malunion, and osteomyelitis. [4][5][6][7][8] Treatment modalities include nonoperative management, fixation with plates and screws, intramedullary nailing, and external fixator devices, and each modality has significant morbidity. [7][8][9][10][11][12] Currently, the optimal management of these injuries remains controversial.…”