Tibial shaft fractures. A comparison of conservative treatment and internal fixation with conventional plates or AO compression plates.

Out of a series of 207 consecutive fractures of the tibial shaft, 102 were treated conservatively, 64 fractures were treated by AO compression plate osteosynthesis and 41 by internal fixation using Eggers or Lane plates. The choice of method was independent of the extent of soft tissue damage. A follow-up examination of 199 fractures, with a mean observation time of 3.4 years, revealed residual malalignment in 21 per cent of conservatively treated cases and in 8 per cent after conventional plate fixation, while the AO method resulted in anatomical restoration of the axis of the tibia in all cases. However, removal of the compression plates was followed by re-fractures, early and late, in 11 per cent. Implant failure occurred in 5 per cent of both types of plate fixation, and 3 per cent of the conservatively treated cases redislocated. Infection developed in 5 per cent of closed fractures and in 11 per cent of open fractures treated by operative means. Of the conservatively treated cases, only 3 per cent of the open fractures developed infection. The risk of infection following acute internal fixation is thus four times greater than with conservative treatment. AO compression plate fixation shortened the time of fracture healing considerably. The rate of non-union after conservative treatment was 6 per cent in closed and 21 per cent in open fractures. Similarly in conventional plate fixation there was non-union in 8 and 24 per cent, respectively. Non-union was not encountered after AO compression plate osteosynthesis. It is concluded that AO plate osteosynthesis is justified in the treatment of open tibial shaft fractures and also useful in closed fractures when conservative treatment does not lead to stable reduction with a good alignment.