Fractures of the Tibial Shaft (including Acute Compartment Syndrome)

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Tibial shaft fractures are the most common diaphyseal fractures in adults. Epidemiological data from Edinburgh, UK, suggest an incidence of 2 fractures per 10,000 population per year. The most common single cause in this series was motor vehicle accidents, (which accounted for more than 50% of fractures), followed by sport (predominantly soccer). Twenty-four percent of the fractures in this series were open injuries. Whilst these figures will differ widely between centres, it is clear that tibial shaft fractures represent a wide spectrum of injury patterns. They vary from simple, low-violence fractures, which can often be reliably managed by non-surgical treatments, to violent, high-energy fractures, often associated with severe local soft tissue damage or injury to other body areas, which will require multidisciplinary surgical care (Figure 1). There are several methods of treatment for tibial shaft fractures, and controversy exists as to which (if any) is superior. The authors believe that no method of treatment is universally applicable. Each method has its merits, and a competent surgeon should be capable of applying the most suitable treatment for any particular patient. This decision should be guided by the factors listed in Figure 2, and surgeons may occasionally have to accept that a particular injury lies beyond their ability to treat, and consider seeking help from colleagues.