Critical analysis of results of treatment of 201 tibial shaft fractures.

Two hundred one tibial shaft fractures, 160 closed and 41 open (Grades I and II), were treated between January 1978 and June 1982. Sixty patients underwent closed intramedullary Arbeitsgemeinschart Osteosynthesisfragen/Association for the Study of Problems of Internal Fixation (AO/ASIF) nailing with reaming and 141 patients were treated with closed reduction and cast immobilization. Intramedullary nailing resulted in one (1.7%) nonunion, two (3.3%) infections, and no malunions. In the cast treatment group there were 14 (9.9%) delayed or nonunions, two (1.4%) infections, and six (4.3%) malunions. Within this group there were 19 early failures from either inadequate reduction or loss of reduction, which led to a change from nonoperative to operative methods of management. The interval between injury and return to work was 22 weeks in the nailed group, compared with 25.8 weeks in the cast immobilization group.