MOJ Orthopedics & Rheumatology Minimal Fixations for Treatment of Closed Segmental Fractures of Tibial Shaft in Adults Volume 2 Issue 5 - 2015 Ayyoub A Mohammed 1 *, Mohanad H Hasan 2 and Rami Ahmed 3 1 Department of Surgery, Al-Anbar University, Iraq 2 Al-Ramadi Teaching Hospital, Iraq 3 Al-Hilal Private Hospital, Iraq *Corresponding author: Ayyoub A Mohammed, Department of Surgery, College of Medicine, Al-Anbar University, Iraq, Tel: +9647700008596; Email: Received: May 13, 2015 | Published: June 06, 2015 Abstract Objective: Aim of the study is to evaluate the union rate, alignment and infection rate in treatment of closed segmental fractures of tibial shaft in adult by minimal fixations (internal and external). Patients and Methods: From April 2009 to January 2014, we treated 91 patients with high-energy fractures of the tibial shaft at Orthopedic Department of Al- Ramadi Teaching Hospital. Twenty patients were suitable for our study that had closed segmental fractures of tibial shaft (42-C2 / AO classification), treated by minimal, internal and external, fixations with follow up range from 6 months to 1 year. Results: The union rate was 85% with the expected time 12-24 weeks, 10% pass to delayed union and take average of 4 weeks more than the expected date; only 5% developed non-union and need bone graft to enhance union. The ranges of varus-valgus angulation were 0o-4o, while posterior-anterior angulation were 0o-3o. Six patients developed superficial pin tract infection and responded well to antibiotic therapy and local hygiene. No patient developed full picture of osteomyelitis, or deep infection. Conclusion: Because of high rate of success and less invasive surgery, we concluded that using the minimal fixations (internal and external) in the treatment of closed segmental fractures of tibial shaft (42-C2) in adults is a good choice alternative to locked intramedullary nail fixation. Keywords: Fracture; Fixation; Tibia; Segmental Submit Manuscript | http://medcraveonline.com MOJ Orthop Rheumatol 2015, 2(5): 00067 Introduction Fractures of the shaft of the tibia cannot be treated by a simple set of rules. By its very location the tibia is exposed to frequent injury [1]. Segmental fractures define as; at least two fracture levels (bifocal, trifocal), separating one or several intermediate fracture fragments of tubular bone with intact circumferential cortex of intermediate segments, (AO type 42-C2) [2] often occur after a high energy direct trauma with consecutive severe soft tissue injury and a high energy fractures. Every fracture is an individual problem because ofthe blood supply of the intermediate bone fragment can be severely disturbed, and therefore the decision to treat it by internal fixation or, indeed, conservatively should be based on a realistic assessment of the advantages and the hazards of each method in the circumstances of that particular case. This calls for a high degree of clinical judgment, which is harder to acquire, or to impart, than technical virtuosity in the operating theater. The indications for operative and non-operative treatment of tibial shaft fractures have not been well defined [3]. Patients & Methods From April 2009 to January 2014, we received 91 patients with high-energy fractures of tibial shaft at orthopedic department of Al-Ramadi Teaching hospital. 20 patients were suitable for our study and their closed fractures meeting the AO classification criteria for segmental type: fracture of the tibia presenting two distinct shaft fractures isolating a cylindrical cortical segment measuring several centimeters (42-C2). Those excluded from our study, are shown in Table 1. There were 17 (85%) men and 3 (15%) women, who sustained 12 (60%) fractures of the right tibia and 8 (40%) fractures of left tibia. The average age of the patients was 43 years (range 23 to 62 years). The mechanisms of injury were shown in Table 2 below, mostly due to motorcycle accident, which lead to high-energy fractures of tibial shaft. Fractures of tibial shafts were classified according to criteria of AO/ASIF classification as type 42-C2. Table 1: Cases excluded from the study. Case No. Open Fractures 36 Fractures Other than 42-C2 14 Fractures with Neuro-vascular Injuries 2 Fractures with Compartment Syndrome 4 Fractures with incomplete follow up 3 Age Below 20 years 7 Fractures Associated with other Injuries 5 Total 71 Research Article