Tibial shaft fractures : An epidemiological and clinical study

Sammanfattning: The epidemiological features of tibial shaft fractures were studied in Uppsala during two 5-year periods. The incidence decreased in men below 20 years of age in the late 1980's compared with the early 1970's (mostly due to a reduction of fractures sustained in traffic accidents), while the incidence increased in women over 80.67 patients with closed tibial shaft fractures treated with a unilateral external fixation were examined after 1-5 years. The major drawbacks were prolonged healing time and recurrent need for unplanned secondary operations. The majority of the complications were either related to the pin tracts or to insufficient mechanical stability. 37 infected tibial shaft nonunions treated by debridement and open autogenous cancellouos bone grafting in a 2-stage procedure were followed for 2 years. In 12 cases additional debridement was necessary before bone grafting. All fractures healed. Open cancellous bone grafting is considered to be a simple and reliable technique.In 32 patients the effect of low-intensity ultrasound in fracture healing in closed or open grade I fresh tibial fractures treated with an intramedullary nail was studied. Contrary to previous reports the ultrasound treatment did not shorten the healing time.In 30 patients from the previous study the serum bone markers (pyridinoline cross-linked telopeptide of type I collagen, bone-specific alkaline phosphatase and osteocalcin) were measured ten times during one year. Ultrasound treatment seemed to reduce the early bone resorption, while it did not seem to have any effect on bone formation. Patients with delayed healing had a much slower rise in bone-specific alkaline phosphatase compared with the profile in patients with normal healing time.31 patients with closed or open grade I fresh tibial fractures were treated with an intramedullary nail, followed by immediate mobilisation and early weight-bearing. Very limited bone loss was found in the proximal part of ipsilateral femur and calcaneus during the first postoperative year.