Abstract

• Fracture of the tibia is the most common fracture of the long bone and due to its anatomical property, significantly high rate of complication has been reported during and after treatment. Various ways of surgical treatment have been tried with reasonable satisfaction. Recently, closed intramedullary nailing under the image intensifier has been widely performed with good results. However, segmental tibial fractures are more difficult than ordinary tibial shaft fracture in terms of reduction and fixation. Its treatment has been rather challenging for average orthopedic trauma surgeons. Particularly, segmental tibial fractures are commonly combined with extensive soft tissue injury, comminution as well as displacement resulted in poor blood supply especially in its middle segment. In this paper we are reporting our experience with intramedullary nailing treatment for 13 segmental tibial fractures in 13 patients. 13 cases with segmental fracture of tibia were reviewed, which were treated at the Deparment of Orthopaedic Surgery, Kang-Dong Sacred Hospital of Hallym University for 6 years from January 1990 to December 1996 with more than 1 year follow up period. All cases were caused by traffic accident and four were open fractures. Patients were 19-60 years of age (average 44) with male to female ratio of 1.6:1. The fractures were closely reduced and intramedullary nailed under the image intensifier control. Two cases were added with limited skin opening of the displaced fragments for reduction. Seven cases were reenforced an additional immobilization such as long leg splint or cast or externl fixator postoperatively. Melis type I fractures were most frequent in our series. All fractures were healed within a 1 year and average union period was 167 days (proximal fracture-144 days, distal fracture-190 days). Complications were a case of chronic osteomyelitis and one deep vein thrombosis and 4 case of delayed union, which were treated by reoperation with bone grafts. Displacing most proximal fragment was most troublesome to manage during and after operation. We tried intracortical screws fixation between proximal and middle segments with satisfactory bony union without displacement for a case. Carefully planned intramedullary nailing with or without some modification of the most proximal and shoryt segment seems to be recommendable way of treatment for the most segmental fractures of the tibia.
• Key words: Tibia, Segmental Fracture, Intramedullary Nail

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