Treatment of Closed Tibial Fractures

Closed tibial shaft fractures are the most common long-bone fractures, resulting in approximately 77,000 hospitalizations, 569,000 hospital days (average length of stay, 7.4 days), and 825,000 office visits per year 1. Closed tibial shaft fractures in young patients are most commonly sport-related injuries, whereas simple falls cause most of the closed tibial shaft fractures in the elderly. The fracture pattern of closed tibial fractures is usually simple, with less severe soft-tissue injury than is seen with open tibial shaft fractures 2. The more complex fracture configurations are frequently seen in older, less fit patients with osteoporotic bone 2. There are several ways to classify closed tibial shaft fractures, depending on whether the goal is to communicate the bone injury (fracture pattern) or the soft-tissue injury associated with the fracture. Most surgeons classify tibial shaft fractures with simple descriptive terms such as proximal, middle, or distal in addition to transverse, oblique, spiral, segmental, or comminuted. The benefits of a simple classification such as this are familiarity with the terms and a high degree of understanding of what the terms represent. The disadvantages are ambiguity and subjectivity, which make simple classifications less useful for publication and research purposes. The two most commonly used classification systems are the AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) classification of bone injury 3 and the Tscherne and Gotzen classification 4 of soft-tissue injury associated with closed tibial shaft fractures. The AO/OTA classification is an alphanumeric system based on the bone involved and the particular region of the bone involved 3. Generally, the letters A, B, and C are used to designate groups of fractures of increasing severity. These groups are then subdivided, with the numbers 1, 2, and 3 indicating increasing complexity (i.e., comminution) within groups 3. Tscherne and Gotzen described four …