Concept of conservative management of displaced tibial shaft fractures in advanced orthopaedic era of internal fixation

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.14th 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.