Rotational refracture of the shaft of the adult tibia.

The incidence and clinical details of refractures of the shaft of the tibia a series of 534 adult patients after conservative primary treatment were analysed. Fracture of the callus is defined as a secondary fracture occurring within twelve months of the primary injury in the area of bone healing by callus. A fracture of the callus was recorded in 13 patients (2.4 per cent), in whom 11 fractures occurred after a primary fracture caused by indirect, rotational violence. The incidence among these was 6.3 per cent. For torsional fractures of the tibial shaft the following factors were associated with appreciably increased frequency of subsequent fracture of the callus: repeated closed reduction; fracture of the fibula at a different level from that of the tibia, and marked initial lateral displacement. When these factors were present simultaneously, the incidence was 18 per cent.