Outcomes of the isolated closed tibial shaft fractures treated nonsurgically

Background: Fractures of the tibia are important for their commonness and controversy in their management. 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. The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures. Methods: All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment. Results: Of the 26 patients examined, males were more commonly affected. The mean age was 27.46 (SD=7.58). The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36). Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%). All fractures eventually healed in an average of 13.7 weeks (SD=3.24). There was one case of delayed unio‎n in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10° in 2 (7.69%) patients. Moreover, in 4 (15.38%) patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77%) patients. No patient had non-unio‎n, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome. Conclusion: Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and selecting patients satisfying restricted criteria. Moreover, considering long-term physical disability with longer follow-up period, it seems that there still is a controversy in the treatment selection even for the simple tibial fractures.