On the behavior of closed tibial fractures: Clinical/radiological correlations

Objective: To review the treatment of closed diaphyseal tibial fractures wi th functional braces and to identify patient and fracture characteristics, as well as possible correlations, that could be used to determine final out comes. Design: A comprehensive review of data obtained from 1,000 diaphyseal tibia l fractures. Setting: Major university teaching hospital. Intervention: Identification of patient and fracture characteristics, inclu ding type and level of fracture, initial shortening and angulation, and sev erity of injury, to be correlated with final shortening and angulation and speed of healing. Main Outcome Measurements: Degree of shortening and angulation; speed of he aling. Results: Neither the level nor the type of tibial fracture significantly in fluenced healing time, although there was a considerably higher probability of delayed union in fractures produced from vehicular accidents, as well a s in comminuted and segmental fractures. Any delay in application of the fu nctional brace resulted in slower healing. Maximum shortening of the fractu res occurred at the time of the initial injury, with no additional shorteni ng experienced after the introduction of graduated weight-bearing ambulatio n. Compared with a mean initial shortening of 4.25 millimeters, the overall final shortening of fractures was 4.28 millimeters. Conclusions: Correlations exist between patient and fracture characteristic s that influence the final outcome for closed diaphyseal fractures treated with functional braces.