Značaj odabira dijagnostičkih i terapijskih modaliteta na ishod lečenja preloma dijafize tibije

Abstract

Fractures of the tibial shaft are the most common fractures of long bones. Open fractures of the tibial shaft often lead to simultaneous severe soft tissue and bone damage. The absence of adequate soft tissue coverage, together with the specific blood supply to this region, makes these fractures susceptible to infection and non-healing. A thorough patient evaluation, including diagnosis of soft tissue and bone damage, is essential for the successful treatment of tibial diaphysis fractures. The medical importance of tibial diaphyseal fracture on the one hand, and the uncertainties that exist when it comes to treatment, on the other hand, impose the need to examine the best therapeutic modalities in patients with tibial diaphyseal fracture. In addition to conservative treatment, which is reserved for fractures without dislocation of fracture fragments, the most common approach is surgical treatment - with external fixators or intramedullary fixation with nails. Today, intramedullary fixation takes precedence in the treatment of most fracture types. Ilizarov external fixator is still the method of choice in patients with multiple traumas. Most studies did not observe a significant difference in the frequency of postoperative complications between the two methods, such as delayed healing and fracture nonunion, however, numerous studies indicate more frequent superficial infections in patients treated with an external fixator, or deep infections in patients treated with intramedullary pins. Each of the mentioned complications additionally burdens both the surgical team and the patient, i.e. the success of the treatment and functionality, together with the quality of life after the treatment is completed. Therefore, it is necessary to conduct larger, prospective, and multicenter studies on complication rates, which will help in choosing the most adequate treatment method for tibial diaphysis fractures.