Revue de chirurgie orthopédique et réparatrice de l'appareil moteur
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Rev Chir Orthop Reparatrice Appar Mot · Sep 2003
[Segmental tibia fractures: a critical retrospective analysis of 49 cases].
Segmental tibia fracture is defined by the presence of two distinct fracture lines separating the cortical and completely isolating an intermediary segment of the tibia. Little work has been published on this clinical entity. We report a retrospective analysis of 49 patients treated in one center for segmental tibia fracture in order to determine more precisely the indications for three surgical techniques: locked intramedullary nailing with or without reaming, and external fixation. ⋯ Comparing our results with the therapeutic modalities used in published reports on segmentary tibia fractures showed that time to bone healing and the rate of nonunion were generally greater than in our series. A critical analysis of these results allows us to propose a more interventionalistic attitude before the development of late healing. We also propose a classification of segmental tibia fractures and a decisional tree for choosing between the three techniques based on the presence of soft tissue damage, the presence of compartment syndrome (nailing without reaming), and the presence of proximal or distal metaphyseal fractures (distal locked nail). Nailing with moderate reaming remains the preferred method.