My Orthopaedic Surgeon

IM Nailing for Open Tibial Fractures

Closed Fractures Tibial shaft fractures: Closed Reduction versus ORIF

Accelerated tibial fracture union in the third trimester of pregnancy: a case report Mudussar A Ahmad , Damayanthi Kuhanendran , Irvine W Kamande and Charalambos Charalambides (Abstract and full text available) Journal of Medical Case Reports 2008, 2:44
We present a case of accelerated tibial fracture union in the third trimester of pregnancy. This is of particular relevance to orthopaedic surgeons, who must be made aware of the potentially accelerated healing response in pregnancy and the requirement for prompt treatment.

Medscape 2000

OTA paper 1998

Illustrated classification of tibial shaft fractures

Reports from Medscape Orthopaedics and Sports Medicine 1999
Ipsilateral femoral neck and shaft fractures
Fracture Healing in Tibia Fractures With an Associated Vascular Injury
The Treatment of Lisfranc Injuries
Open Fractures of the Patella: Long-term Functional Outcome

Medscape Conference Coverage from American Academy of Orthopaedic Surgeons Annual Meeting Day 4 - Saturday, March 18. Overview of the controveries of intramedullary nailing in femoral shaft fractures and severe open tibial fractures.

The tibia and the fibula are perhaps the most commonly injured bones of the lower extremity, the tibia alone being the subject of controversy and ongoing discussion on the methods of treatment. Despite newer innovations in implants and external fixation devices, the tibial fracture essentially remains unsolved; it is one of the most challenging fractures to be treated by an orthopedic surgeon. These injuries are different and variable in presentation, and their outcomes are unpredictable.
Synonyms and related keywords: tibia fractures, lower-leg fractures, lower-extremity fractures, leg fractures, lower extremity fractures, broken leg, lower leg fractures, tibial fractures
Poduval & Kale 2007

Displaced tibial shaft fractures: A prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients Authors: Karladani A.H.; Granhed H.; Edshage B.; Jerre R.; Styf J. Source: Acta Orthopaedica Scandinavica, Volume 71, Number 2, 1 April 2000, pp. 160-167(8) Abstract: Of 53 patients with unilateral, displaced and closed or grade 1 open tibial shaft fractures, 27 patients (group I) were randomized to treatment with an intramedullary nail and 26 patients (group II) to treatment with a plaster cast. 12 fractures in the latter group were considered stable enough for treatment with only a cast (group IIa), while 14 fractures in group II showed redisplacement during reduction under anesthesia or at 1 week follow-up. Therefore, these fractures were stabilized with cerclage or screws (group IIb), which was a prerequisite for continuing cast treatment. The mean time-to-union was 19 weeks for group I, and 25 weeks for group II. 6 patients in group I and 16 in group II had delayed union. The Nottingham Health Profile index scores on physical mobility, social isolation, work ability, and sexual life were significantly better in group I than in group II at 3 months after injury. Delayed union, malunion, and restricted range of motion at the ankle joint were common complications when these fractures were treated with a cast. We recommend intramedullary nailing for these fractures. Full Text available

Wheeless Textbook of Orthopaedics Distal Tibia Fracture: with frx extension into the joint, consider placement of percutaneous lag screws to repair intra-articular fracture lines before nailing is performed; ORIF of distal fibula: some authors recommend concomitant ORIF of the distal fibula (if frx is present), inorder to improve rotational stability; blocking screws: antero-posterior blocking screws are inserted on either side of the central nail insertion zone inorder to effect an anatomic reduction; with fracture demonstrating preoperative varus displacement, consider an antero-posterior blocking screw inserted on the medial side of the distal fragment; in contrast distal fractures with tendency for valgus displacment, consider placement of AP blocking screw inserted on the lateral side of the distal fragment;

OTA poster 2004

External Fixation for Open Type IIIB Tibial Fratures

OTA Poster 2004: The purpose of this study was to examine a large population of patients treated with intramedullary nailing to determine factors associated with increased radiation exposure.

Fibular fixation as an adjuvant to tibial intramedullary nailing in the treatment of combined distal third tibia and fibula fractures: a biomechanical investigation P.M. Morin, R. Reindl, E.J. Harvey, L. Beckman, T. Steffen Can J Surg, Vol. 51, No. 1, February 2008
Conclusion: Fibular plating in addition to tibial IM fixation of distal third tibia and fibula fractures leads to slightly increased resistance to torsional forces. This small improvement may not be clinically relevant.