Faisal Masood, Hamid Qaymn.
Clinical study of outcome of close management of Diaphyseal Fractures of Tibia in adults.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;15(2):71-6.
Tillie to fracture healing and factors that resulted in subsequent loss of alignment were evaluated in fifty patients with closed and Gustilo grade I open fractures of tibial shaft after treatment by closed manipulation under intravenous analgesia and long leg plaster cast immobilization. Five patient were lost to follow up. There were 34 male and 11 females with mean age of 32 years (range 16-70 years). Patients were followed up for the maximum of 27 weeks. 78% fractures were inflicted in motor bike accidents in young adult males. There were 32 closed and 13 open fractures. There were 12 transverse, 11 oblique, 5 spiral, 14 comminuted and 3 segmental fractures. 17 fractures subsequently developed displacement requiring wedging in 12 cases and remanipulation in 5 cases. Surgical treatment was carried out in seven cases; for persistent displacement in five and non union in two cases. Average healing tune with closed treatment was 17 weeks range 10-27 weeks. Transverse and short oblique fractures healed faster. Factors which were responsible for loss of reduction included, fracture tibia arid fibula at same level, significant swelling. Angulation > 20°, shortening > 2cm, contact < 50%, difficulty with initial reduction and comminuted and long oblique fractures. Fracture geometry appeared to be a major factor but more than 1 factor were responsible in combination. It is concluded that closed management is a safe mode of treatment for closed, and grade I open fractures of tibia. Marked initial displacement, difficulty with reduction, shortening > 2cm, long oblique and comminuted fracture have greater tendency to displace and require closed observation. Segmental fractures are difficult to treat by closed method and should have primary internal fixation.
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