[Conservative management versus osteosynthesis in the treatment of tibial shaft fractures].

Treatment was rendered to 1,693 patients with 1,728 tibial shaft fractures at the University Hospital of Granada, Spain, between 1971 and 1987. After 139 patients had died, 1,554 patients with 1,571 tibial fractures were actually left for treatment. Forms of fractures were subdivided according to Johner and Wruhs. Conservative treatment, according to Böhler-Sarmiento, was applied to 589 cases, while surgery was performed on 982. Different ways of osteosynthesis were used, including tibial plates (n = 284), intramedullary nailing according to Küntscher (n = 308), and lock nailing according to Klemm (n = 336). Other methods of osteosynthesis, such as elastic nailing according to Ender (n = 36) and external fixation (n = 18) were rarely used and, therefore, were not statistically evaluated. --The author's result have provided evidence to the effect that conservative treatment according to Böhler (and modified by Sarmiento) worked well, with only 11.4 per cent complications in cases of closed and open fractures. However, only moderate results were obtained from follow-up checks, since compensation was usually not possible for the majority of primary lateral fragment displacements, so that for consolidation limbs had to be kept immobilised for much longer periods of time, and this entailed poor functional results. --Very poor results were obtained from plate osteosynthesis, in the context of surgical treatment, with the rate of complications being as high as 34.9 per cent. Better results were achieved by intramedullary nailing, with complications in 14.9 per cent of all cases. Yet, it is the author's view that lock nailing has become the established optional method.