High-energy tibial shaft fractures

Abstract

High-energy trauma is the leading cause of death in the 18-44 age group worldwide. In the United States loss of income due to death and disability resulting from high energy trauma is 75 billion dollars annually. High-energy injuries are so named because of the amount of energy that is transferred to the patient' body at the moment of impact. Typical high­ energy traumas are motor vehicle accidents, especially those involving pedestrian or motor cycle riders, fall from a height and some industrial accidents and military wounds. High-energy tibial shaft fractures are among the commonest injuries resulting from high-energy trauma. Skeletal fixation of tibia fractures resulting from high-energy trauma has undergone a number of fundamental changes over the past few decades. These changes are because, in part, of a better understanding of the intimate association between the disruption of the soft tissue envelope of the tibia and the osseous injury, increased implant choices, and the development of protocol-driven studies to evaluate treatment options

Current fixation principles of open fractures are based on Gustillo and Anderson's classification scheme, originally published in 1976 and modified in 1984.Soft tissue injuries found in association with c.losed tibial fractures, as classified by Tscheme and Gotzen, have also been shown to have clinical and therapeutic significance. These soft tissue classification schemes represented a major step forward in the treatment of tibial fractures, and they facilitated a description of the injury, which was then used to guide treatment protocols and evaluate outcomes. The development of aggressive and emergent protocol-driven management of soft tissue injuries in association with tibia fractures has markedly improved outcomes, regardless of the fixation method.