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1Principles

Appropriate surgical strategy is sequential, stepwise reduction of the fracture planes.

General considerations

Intact segmental  fractures are high energy injuries, and may have significant closed or open soft-tissue damage. However, either, or both, fracture planes may have simple patterns, for which absolute stability is beneficial.
While compression plating may be appropriate for the transverse fracture components, significant comminution at any part of an intact segmental fracture should  suggest fixation with relative stability, using either an intramedullary nail or bridge plating.
Utmost care is necessary to protect soft tissues attached to intermediate fragments, to avoid devascularization.
Appropriate surgical strategy is sequential, stepwise reduction of the fracture planes, as illustrated. The idea is to proceed stepwise, reducing and stabilizing one fracture line at a time.

The following fracture example illustrates several possible options for compression plating of less comminuted segmental fractures. Treatment for any segmental tibia fracture must be planned and executed according to its specific injury patterns, as well as general principles.