Treatment of closed tibial fractures.

Closed tibial shaft fractures are common injuries that remain challenging to treat because of the wide spectrum of fracture patterns and soft-tissue injuries. Understanding the indications for surgical and nonsurgical treatment of these fractures is essential for good outcomes. Although cast treatment of stable tibial shaft fractures has traditionally been successful and continues to be widely used, recent clinical studies have shown that intramedullary nails may be more advantageous for fracture healing and function than casting. Surgical treatment (intramedullary nailing, plate fixation, or external fixation) of closed tibial shaft fractures varies depending on multiple factors. Metaphyseal fractures are well suited for plates, although newer intramedullary nail designs provide the option of intramedullary nailing of proximal or distal metaphyseal tibia-fibula fractures. External fixators are well suited for skeletally immature patients with unstable fracture patterns or for patients with unacceptably small intramedullary canals. Interlocking intramedullary nails are the treatment of choice for most unstable tibia-fibula shaft fractures.

[1]  C. Krettek,et al.  The mechanical effect of blocking screws ("Poller screws") in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. , 1999, Journal of orthopaedic trauma.

[2]  P. Tornetta,et al.  Intraarticular anatomic risks of tibial nailing. , 1999, Journal of orthopaedic trauma.

[3]  A. Ruiz,et al.  Dia-metaphyseal distal tibial fractures--treatment with a shortened intramedullary nail: a review of 15 cases. , 2000, Injury.

[4]  J. Keating,et al.  Cigarette smoking and open tibial fractures. , 2001, Injury.

[5]  P. Tornetta,et al.  Semiextended Position for Intramedullary Nailing of the Proximal Tibia , 1996, Clinical orthopaedics and related research.

[6]  E H Schemitsch,et al.  Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia , 1995, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[7]  K. Lertola,et al.  Leg tissue perfusion in simple tibial shaft fractures treated with unreamed and reamed nailing. , 1997, The Journal of trauma.

[8]  T. P. rd.  Technical considerations in the surgical management of tibial fractures. , 1997 .

[9]  E. Schemitsch,et al.  Cortical bone blood flow in loose and tight fitting locked unreamed intramedullary nailing: a canine segmental tibia fracture model. , 1998, Journal of orthopaedic trauma.

[10]  J. Keating,et al.  Infection after intramedullary nailing of the tibia. Incidence and protocol for management. , 1992, The Journal of bone and joint surgery. British volume.

[11]  C. Court-Brown,et al.  The epidemiology of tibial fractures. , 1995, The Journal of bone and joint surgery. British volume.

[12]  J. Watson,et al.  Intramedullary Nailing of the Tibia Without a Fracture Table: The Transfixion Pin Distractor Technique , 1994, Journal of orthopaedic trauma.

[13]  E. Lambiris,et al.  Interlocking intramedullary nailing in distal tibial fractures. , 2000, Orthopedics.

[14]  J. Keating,et al.  Reamed interlocking intramedullary nailing of open fractures of the tibia. , 1997, Clinical orthopaedics and related research.

[15]  P. Blachut,et al.  Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft. A Prospective, Randomized Study* , 1997 .

[16]  C. Krettek,et al.  Accuracy of intramedullary templates in femoral and tibial radiographs. , 1996, The Journal of bone and joint surgery. British volume.

[17]  E. L. Freedman,et al.  Radiographic analysis of tibial fracture malalignment following intramedullary nailing. , 1995, Clinical orthopaedics and related research.

[18]  C. Krettek,et al.  The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails , 1999 .

[19]  C. Court-Brown,et al.  Closed intramedullary tibial nailing. Its use in closed and type I open fractures. , 1990, The Journal of bone and joint surgery. British volume.

[20]  R. Rubinstein,et al.  Intramedullary interlocked tibia nailing: a new technique (preliminary report). , 1992, Journal of orthopaedic trauma.

[21]  A. Rüter,et al.  The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures , 2001, Archives of Orthopaedic and Trauma Surgery.

[22]  A. Schmidt,et al.  A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. , 2000, Journal of orthopaedic trauma.

[23]  J. Anglen,et al.  A comparison of reamed and unreamed nailing of the tibia. , 1995, The Journal of trauma.

[24]  K. Buehler,et al.  A technique for intramedullary nailing of proximal third tibia fractures. , 1997, Journal of orthopaedic trauma.

[25]  D. Seligson,et al.  Treatment of closed tibia shaft fractures: a survey from the 1997 Orthopaedic Trauma Association and Osteosynthesis International--Gerhard Küntscher Kreis meeting. , 2000, Journal of orthopaedic trauma.

[26]  A. Kyrö.  Malunion after intramedullary nailing of tibial shaft fractures. , 1997, Annales chirurgiae et gynaecologiae.

[27]  E. J. Hargadon,et al.  Is conservative treatment of displaced tibial shaft fractures justified? , 1984, The Journal of bone and joint surgery. British volume.

[28]  M. Swiontkowski,et al.  Closed Fractures of the Tibial Shaft: A Meta-Analysis of Three Methods of Treatment* , 1998, The Journal of bone and joint surgery. American volume.

[29]  G J Hooper,et al.  Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial. , 1991, The Journal of bone and joint surgery. British volume.

[30]  P. Trafton.  Closed Unstable Fractures of the Tibia , 1988, Clinical orthopaedics and related research.

[31]  S. Weissman,et al.  Fractures of the middle two-thirds of the tibial shaft. , 1966, The Journal of bone and joint surgery. American volume.

[32]  P. Stegemann,et al.  Displaced Isolated Fractures of the Tibial Shaft Treated with Either a Cast or Intramedullary Nailing. An Outcome Analysis of Matched Pairs of Patients* , 1997, The Journal of bone and joint surgery. American volume.

[33]  J. McElwain,et al.  Patellofemoral contact forces and pressures during intramedullary tibial nailing , 1998, International Orthopaedics.

[34]  A. Alho,et al.  Locked intramedullary nailing for displaced tibial shaft fractures. , 1990, The Journal of bone and joint surgery. British volume.

[35]  A. Tencer,et al.  Influences of Some Design Parameters on the Biomechanics of the Unreamed Tibial Intramedullary Nail , 1993, Journal of orthopaedic trauma.

[36]  F. Dietz,et al.  Long-term follow-up after fractures of the tibial and fibular shafts. , 1989, The Journal of bone and joint surgery. American volume.

[37]  P. Campbell,et al.  Massive femoral osteolysis and early disintegration of a polyethylene-bearing surface of a total knee replacement. A case report. , 1992, The Journal of bone and joint surgery. American volume.

[38]  J. Keating,et al.  Knee pain after tibial nailing. , 1997, Journal of orthopaedic trauma.

[39]  M. Liebergall,et al.  The unreamed tibial nail in the treatment of distal metaphyseal fractures. , 1999, Injury.

[40]  J. Watson,et al.  Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. , 1997, Journal of orthopaedic trauma.

[41]  P. Worlock,et al.  Complications of Nailing in Closed Tibial Fractures , 1995, Journal of orthopaedic trauma.

[42]  R. Buckley,et al.  A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial. , 1996, Injury.

[43]  S. Bridgman,et al.  Audit of closed tibial fractures: what is a satisfactory outcome? , 1993, Injury.

[44]  B. Uhlin,et al.  Attempted unreamed nailing in tibial fractures: a prospective consecutive series of 55 patients. , 1998, Acta orthopaedica Scandinavica.

[45]  D. E. Matthews,et al.  Anterior unicortical buttress plating in conjunction with an unreamed interlocking intramedullary nail for treatment of very proximal tibial diaphyseal fractures. , 1997, Orthopedics.

[46]  C. Court-Brown,et al.  Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. , 1995, The Journal of bone and joint surgery. British volume.

[47]  C. Court-Brown,et al.  Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. , 1997, Journal of orthopaedic trauma.

[48]  M. Swiontkowski,et al.  Quantitative assessment of bone injury and repair after reamed and unreamed locked intramedullary nailing. , 1998, The Journal of trauma.

[49]  T. Mcconnell,et al.  Tibial portal placement: the radiographic correlate of the anatomic safe zone. , 2000 .

[50]  A. Sarmiento,et al.  Factors influencing the outcome of closed tibial fractures treated with functional bracing. , 1995, Clinical orthopaedics and related research.

[51]  D. Cohen,et al.  Proximal entry for intramedullary nailing of the tibia , 2000 .

[52]  E. V. Lim,et al.  Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. , 1988, The Journal of bone and joint surgery. American volume.

[53]  D. Templeman,et al.  Decision Making Errors in the Use of Interlocking Tibial Nails , 1997, Clinical orthopaedics and related research.

[54]  S. Hou,et al.  Unreamed Locked Tight-fitting Nailing for Acute Tibial Fractures , 2001, Journal of orthopaedic trauma.

[55]  T. Rüedi,et al.  Osteosynthesis of 245 tibial shaft fractures: early and late complications. , 1994, Injury.

[56]  R. Jackson,et al.  A comparison of plating and traction in the treatment of tibial shaft fractures. , 1986, Injury.

[57]  M. Lorio,et al.  Management Protocol for Unreamed Interlocking Tibial Nails for Open Tibial Fractures , 1995, Journal of orthopaedic trauma.

[58]  M. V. van Holsbeeck,et al.  Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results. , 1998, Journal of orthopaedic trauma.

[59]  M. Järvinen,et al.  Anterior Knee Pain After Intramedullary Nailing of Fractures of the Tibial Shaft: A Prospective, Randomized Study Comparing Two Different Nail-Insertion Techniques , 2002, The Journal of bone and joint surgery. American volume.

[60]  B. Cunningham,et al.  Stability of reamed and unreamed intramedullary tibial nails: a biomechanical study. , 1995, Injury.

[61]  Carr Jb,et al.  Biomechanics of Rigid Tibial Nail Insertion Sites , 1996 .

[62]  M. Gross,et al.  Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature. , 2000, Canadian journal of surgery. Journal canadien de chirurgie.

[63]  Nicoll Ea.  FRACTURES OF THE TIBIAL SHAFT. A SURVEY OF 705 CASES. , 1964 .