Adult tibial shaft fractures - different patterns, various treatments and complications.

BACKGROUND: Tibial Fractures constitute a large number of emergency operations in most trauma centers. There are different approaches for tibial fractures. To our knowledge, there is insufficient evidence to consider post-operative complications in relation to both surgical methods and the types of fractures. Our purpose is to report our experience regarding the efficacy and complications associated with diverse surgical methods of different patterns of tibial shaft fractures in adults. MATERIAL/METHODS: We studied 387 adult patients. The patients' information was registered from the charts and after examination. The methods used were intramedullary interlocking nails, simple intramedullary rods, plating and external fixation. Early and late complications were recorded and by applying the DELPHI method different treatments were compared. Finally, the safest mode of treatment is proposed. RESULTS: In the intramedullary interlocking nails method the most noticeable complication was delayed union and the highest rate of complications was seen in open oblique fractures. In the simple intramedullary rods method the most frequent complication was pain, and in the with butterfly fractures the complications were the most. In the plating method the most frequent complication was pain, and most of the complications were seen in open comminuted fractures. Finally, in the external fixation method the most frequent complication was non-union and complications were the highest in the patients with oblique, comminuted and segmented fractures. CONCLUSIONS: The proposed method to treat transverse, oblique and butterfly fractures is simple intramedullary rods; whereas intramedullary interlocking nails is the better method for comminuted, segmented and spiral fractures.

Epidemiology of adult tibial shaft fractures: a 7-year study in a major referral orthopedic center in Iran.

BACKGROUND: Epidemiologic differences among various fracture sites and within different populations are important as they imply different cultures and lifestyles in each region. One of these fractures is the tibial shaft fracture. Rather few epidemiological studies have been undertaken on this injury. This study was designed to provide an update on various aspects of tibial shaft fractures during 1999-2006 in a referral educational orthopedic center in Iran. MATERIAL/METHODS: The charts of 854 adult patients were evaluated in a cross-sectional study. All the patients were examined and the results were registered. The collated information was classified along with descriptive statistical analysis. RESULTS: The highest frequency of these fractures was seen in the 20-30 year age group in both genders, and women had a higher rate than men in people aged > or =50 years old. The most common cause of fractures was road traffic accidents; 54% of all injuries were closed fractures and 46% were open. The most frequent fracture pattern was comminuted and the fewest were segmented and with butterfly fractures. The most noticeable complication early after treatment was infection and those during at least one year follow-up were pain, nonunion, and delayed union. CONCLUSIONS: The peak frequency of tibial shaft fractures in Iran was one decade higher than in European populations and in those > or =50 years old the rate was higher in women, which was two decades lower than the mentioned populations. Furthermore, in this study in addition to high-energy trauma, low-energy trauma also had a great role.