[Indications for and technic in the surgical treatment of tibial shaft fractures with open epiphyseal grooves. A report of 63 cases].

The documentation relating to 63 surgically treated fractures sustained to the shaft of the tibia while epiphyseal growth plates were still in evidence (9 in isolation, 54 as fractures of the lower leg) between 1958 and 1983 was examined with respect to indications for the operation and the method selected. The average age of the patients was 12.9 years. There were 41 closed fractures and 22 open fractures varying in the degree of severity. Bending fractures predominated, with 42 cases, while the other 21 were spiral fractures. The causes were as follow: 32 traffic accidents, 28 sports accidents and 3 of other kinds. Stabilization was achieved either exclusively by wiring of the medulla or cerclage, or by a combination of both methods. Postoperative immobilization was ensured by means of a thigh cast for an average of 12 weeks. In 2 cases, intramedullary nailing was performed. The osteosynthetic material was removed early. Serious complications recorded were infection observed in 2 cases in connection with open fractures. Osseous union occurred in all fractures; no pseudarthroses developed. Absolute surgical indications, in our opinion, are third-degree open fractures, malreduction or instability of second- and first-degree open fractures, secondary dislocations after conservative initial treatment, soft-tissue damage and interposition. Relative indications are first and second-degree open fractures of the tibia and multiple trauma. Pathologic fractures were not considered in the follow up study, in which only 18 patients were examined: their average age was 13.7 (11-16) years.(ABSTRACT TRUNCATED AT 250 WORDS)