ORIGINAL ARTICLE P J M H S VOL. 7 NO.2 APR – JUN 2013 361 Concept of Conservative Management of Displaced Tibial Shaft Fractures in Advanced Orthopaedic Era of Internal Fixation ZULFIQAR ALI QURESHI 1 , SYED WASIF ALI SHAH 2 , MUHAMMAD ZUBAIR 3 ABSTRACT Background: Fractures of tibia are very common but management is controversial which ranges from conservative to different surgical methods. However, standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization. Objectives: To analyze the efficacy of conservative policy in management of isolated displaced tibial shaft fractures. Patients and methods: All cases of the diagnosed displaced tibial shaft fracture were treated conservatively at Social Security Teaching Hospital, Lahore during two years period w.e.f.14 th August, 2007 to 13 th August, 2009. All displaced fractures of shaft of tibia in patents above 16 years of age were included. Conservative policy was adopted that included early bone grafting when indicated. Those fractures involving the knee or ankle joint and undisplaced fractures in adults were excluded. Results: The healing time in comminuted fractures varied from 19.2 to 25.3 weeks depending on degree of communition and that of displaced fractures varied from 18.4 to 25.2 weeks. Even slightly compound wounds <1 inch in length had a noticeably delayed union time of 25.4 weeks. Only small puncture wounds, compound from within had no effect on union time i.e. 18.5 weeks. Varus deformity less than 14 degree (12.5%) being the most common and valgus over 14 degree found nil. Conclusion: Basically conservative policy of treatment is satisfactory if early bone grating is performed when indicated, bony union of all displaced tibial shaft fractures is possible in reasonable period of time. Key words: Conservative policy, Early bone grafting, Long leg plaster cast INTRODUCTION Fractures of the tibia are common due to its superficial location. However their management remains controversial. Management of tibial shaft fractures is often complex and disagreement exist about the optimal method of treatment. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization. 1,2 Sarmiento 3 and Tausch et al 4 supported conservative management. However the great advances in orthopaedic, especially with regard to methods of rigid internal fixation have swung the pendulum in this direction. Christensen et al 5 and Wagner 6 stated that “rigid internal fixation is advocated for all displaced fractures of the shaft of the tibia and is advocated as an urgent procedure especially in open fractures”. In their opinion operative treatment was mandatory in every case of displaced tibial shaft fractures. The literature shows a decline in popularity of the bone plate which is designed to hold the fracture rigidly. This decline is traceable to two main trends of ----------------------------------------------------------------------- 1 Department of Orthopaedics, University of Lahore/Social Security Teaching Hospital Lahore, 2 Department of Orthopaedics, Shaikh Zayed Hospital Lahore, 3 Department of Anatomy, Mohtarma Benazir Bhutto Shaheed Medical College, Chittar Pari, Mirpur AJK Correspondence to Dr. Zulfiqar Ali Qureshi, email: dr_zulfikar_ali@yahoo.com opinion. First, the belief that any method which prohibits all movement at the fracture site removes the essential stimulus to callus formation and thus the fracture healing becomes indolent; and second, the widely held belief that absorption of bone ends occurs and that any method which keeps the fragments apart after this absorption is likely seriously to impede the natural healing process. Because of these beliefs conservative treatment is the acceptable method. PATIENTS AND METHODS This prospective study was carried out at Social Security Teaching Hospital, Lahore during two years period w.e.f.14 th August, 2007 to 13 th August, 2009. Eighty diagnosed cases of isolated displaced tibial shaft fracture were treated conservatively additionally with early bone grafting when indicated. All displaced fractures of shaft of tibia in patients with age above 16 years were included. Those fractures involving the knee or ankle joint and undisplaced fractures in adults were excluded. 20% cases required bone graft and the healing time was 36 weeks. Whereas fractures that healed primarily took on average 17 weeks. The number of complications, most of which were minor, was considered acceptable. The precise nature of conservative treatment used depended on the nature of the fracture. In low velocity injuries with little soft tissue damage closed reduction under