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July 13, 1957


Author Affiliations

U. S. Army

Chief, Orthopedic Service, Madigan Army Hospital, Tacoma, Wash.

JAMA. 1957;164(11):1175-1180. doi:10.1001/jama.1957.02980110001001

• The results of different methods of treating fractures of the shaft of the tibia were studied in 413 patients in one Army hospital. More than 40% of the injuries were connected with automobile and motorcycle accidents. Results were found to be more directly related to the method of treatment than to the location or type of fracture or soft tissue involvement. Fractures of the upper middle fourth of the bone were more frequently open, and damage to the soft tissues was more extensive. Approximately 80% of the cases were treated by nonoperative methods. High rates of infection and nonunion were outstanding in fractures treated by plate fixation. Most of these plates were applied elsewhere as emergencies. Infections occurred in a total of 31 cases, of which 8 were cases in which a closed fracture was treated operatively. A second series of 97 fractures of the tibia were treated in another Army hospital, with similar results. The best results were obtained when closed treatment was feasible and plaster casts were skillfully applied. There should be greater awareness of the dangers of open reduction.