Fractures of the upper-third of the tibial shaft.

Thirty-eight cases of upper tibial shaft fractures were studied. These formed 9.16% of the total 415 cases of tibial shaft fractures, in the present series. The fractures were mainly found in adults, due to high energy trauma and oblique and spiral in nature. 63.16% were simple and 36.84% compound fractures. Twenty-eight cases (73.68%) showed evidence of delayed and non-union, after primary conservative treatment of standard 12 weeks duration, and required secondary conservative or surgical treatment. The average time required for fracture union was ten weeks after the second line of treatment, and least in the surgically-treated group who underwent open reduction, bone graft and plate fixation. Possible factors explaining the high rate of delayed union and non-union in fractures of this region of the tibial shaft are disparity in size of the fractured fragments, proximity of the fracture site to the knee joint, attachment of the popliteus and soleus muscles to the upper popliteal surface of the tibia, disruption of the main nutrient artery of the tibia in the upper third of the shaft. Further experimental observation, offering a new subject for future study, is necessary to establish the causes.