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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Healing and Prognosis of Tibial Fractures:


- See: Tibial Non Unions / treatment methods for tibial defects

- Discussion: determinants in prognosis:
    - infection: (see: tibial infections)
           - worst prognostic feature of tibial fractures is infection;
           - infection is most frequent after high velocity, open injuries w/ skin necrosis;
           - ref: Fractures of the tibial shaft. A survey of 705 cases.
    - soft tissue envelope: (see Gustillo Classification)
           - some consider to be most important prognostic factor influencing outcome;
    - comminution and displacement:
           - amount of initial displacement (most importnat);
           - although tibial shaft frx may heal w/ 100% displacement, delayed union & non unions are more common in adults with this degree of displacement;
           - degree of comminution;
           - presence or absence of infection;
           - severity of soft tissue injury excluding infection;
           - ref: Fractures of the tibial shaft. A survey of 705 cases.
    - fibula intact:
           - in the report by Sarmiento, et al. noted that an intact fibula was associated w/ more rapid union, but was also associated w/ malunion;
           - if the fibula is intact or has healed, resection of 1 inch of fibula may improve loading of the fracture site and stimulate union;
           - some authors reserve fibulectomy for cases in which gross angulatory deformity is present which requires frx re-alignment;
           - reference: Factors influencing the outcome of closed tibial fractures treated with functional bracing.
    - quality of reduction: (accetable goals): (see malunion)
           - > 10 deg of angulation in any plane is unacceptable
           - < 5 deg of varus or valgus;
           - < 10 deg of anterior or posterior angulation;
           - < 10 deg of rotation;
           - < 1 cm for leg length discrepancy;
           - no distraction is tolerated;
           - distraction > 1.6 mm may affect length of healing;
           - 5 mm of distraction may increase healing time to 8-12 months;
    - time to union;
           - low energy frx: 10-13 weeks;
           - high energy frx: 13-20 weeks;
           - open frx: 16-26 weeks
           - type 3B & 3C open frx requires 30 to 50 weeks for sonsolidation;
           - distal tibial fractures may be more prone to non union than proximal fractures due to absence of muscular soft tissue envelope;
           - in the report by Skoog A, et al., the authors studied 64 consecutive patients with a tibial shaft fracture;
                   - 12 months after the injury, 44 percent had not regained full function of the injured leg, although all but two of the patients had returned to preinjury working status;
           - reference:
                   - One-Year Outcome After Tibial Shaft Fractures: Results of a Prospective Fracture Registry 



Classification of type III (severe) open fractures relative to treatment and results.

The healing of closed tibial shaft fractures. The natural history of union with closed treatment.

Factors influencing the outcome of closed tibial fractures treated with functional bracing.

Effects of tibial malalignment on the knee and ankle.

No arthrosis of the ankle 20 years after malaligned tibial-shaft fracture.

Predictors of reoperation following operative management of fractures of the tibial shaft.

Timely Fracture-Healing Requires Optimization of Axial Fixation Stability

Validation of a standardised gait score to predict the healing of tibial fractures




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, July 31, 2012 2:04 pm