Executive Editor: Peter Trafton

Authors: Raymond White, Matthew Camuso

Tibial shaft Multifragmentary frature, intact segmental

General considerations

42-C2

Intact segmental fractures usually have fracture planes which are transverse or short oblique. Associated fibular fractures are common. These are high energy injuries with significant soft-tissue damage. Whether closed or open, there is an elevated risk of compartment syndrome, skin envelope damage, and nerve or vessel injury.

These are unstable injuries, which are usually considered as good candidates for operative treatment, but the possibility of skin and subcutaneous tissue damage may require delay or modified operative approach. Intramedullary nailing or minimally invasive plating, or even initial external fixation are generally preferred to an extensive open procedure. If intramedullary nailing is chosen, take care to ream the intermediate segment gently, to preserve soft- tissue attachments.

Bridge plating is applicable to all multifragmented long-bone fractures where intramedullary nailing or conventional plate fixation is not suitable.

These fractures have a significant risk of delayed or non-union, with deformity, if they are treated nonoperatively. Surgical fixation is thus preferred, unless its risks are excessive. Temporary external fixation can maintain length to aid delayed reduction and fixation, as well as provide stability.

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v2.0 2012-05-13