Tibial Shaft Open Reduction Internal Fixation

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Evolution of Tibial Shaft Open Reduction Internal Fixation

The goals of successful surgical management of tibia shaft fractures are to restore limb length, alignment and rotation. This is most often achieved with the use of an intramedullary nail, however a metal plate with screws as well as an external fixator may also be used. External fixators involve inserting pins into the bone above and below the fracture.

These pins are then connected by rods that are outside the skin. These rods can then be adjusted with the intent of aligning and stabilizing the fracture. This method of fixation is often used in the trauma setting as a temporizing measure, as the soft tissue (e.g. muscle, fat, skin) surrounding the bone may be badly bruised and swollen, which can prevent closure of surgical incisions.

The use of an external fixator allows the surgeon to stabilize the fracture until the swelling goes down and then the definitive surgery can take place. However, the external fixator may be left in place until the fracture heals. This is often avoided if possible, as when compared to intramedullary nails, there is a higher incidence of malalignment, increased time to fracture union and increased time to weight-bearing. External fixators also come with the risk of pin tract infections.

Plate and screws can be used if the fractured portion of the tibia is too proximal or too distal to adequately secure the bone with an intramedullary nail. Although there is greater radiation exposure during the surgery, longer surgical duration and greater difficulty removing the hardware in the event that a secondary procedure needs to be performed, it has been shown to have equivalent time to union and lower postoperative pain when compared to intramedullary nailing.

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