Treatment Of Tibial Diaphyseal Fractures Research Articles

A Comparison of the Outcomes Between Suprapatellar and Infrapatellar Approaches of Intramedullary Interlock Nailing in Patients With Extra-Articular Tibial Fractures.

Background and objective Intramedullary nailing can be considered the current gold standard for the treatment of diaphyseal tibial fractures. Nailing ensures good fracture stability, protection against malalignment, and quick mobilization. The suprapatellar (SP) approach of tibial nailing in the semi-extended position has recently been recommended as a safe and effective surgical technique; it has been gaining significant attention in the orthopedic literature, with fewer complications and reoperations. The approach has been shown to facilitate a reduction in fractures around the knee jointin the semi-extended position, and the extended position of the lower leg allows for easier fluoroscopic imaging. In this study, we aimed to compare the outcomes between SP and infrapatellar (IP) approaches of intramedullary nailingin patients with extra-articular tibial fractures. Method A randomized control trial was conducted over a period of 1.5 years at our tertiary care hospital after obtaining approval from its institutional ethics committee. A total of 60 patients with extra-articular tibial fractures were included in the study, with 30 patients each in the SP nailing groupand the IP nailing group, based on randomized sampling and with the help of radiological exposure in SP and IP nailing as per a previous study. The groups were then compared in terms of KUJALA patellofemoral knee score, operative time, radiation exposure, and time of union. Results When comparing both groups, those treated with the SP approach had better outcomes, including reduced radiation exposure, less pain, decreased operative time, better KUJALA patellofemoral knee score, and faster union. Conclusion Based on our findings of the comparison between SP and IP nailing approaches of extra-articular tibial fractures,the former leads to better and safer outcomes than the latter.

Translated article] Suprapatellar tibial nailing, why have we changed?

IntroductionEndomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time. Material and methodsRetrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analysed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months. ResultsNo differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favour of the SP technique 88.45 (76.44–91.1) vs. IP 69 (49.95–80) (p=.006), with no significant differences in other functional scales analysed. ConclusionsAccording to what has been described so far in the literature, the present study supports the tendency towards SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.

Enclavado de tibia suprapatelar, ¿por qué hemos cambiado?

IntroductionEndomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time. Material and methodsRetrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analyzed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months. ResultsNo differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favor of the SP technique 88.45 (76.44–91.1) vs. IP 69 (49.95–80) (p=.006), with no significant differences in other functional scales analyzed. ConclusionsAccording to what has been described so far in the literature, the present study supports the tendency toward SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.

Minimally invasive percutaneous plate osteosynthesis in treatment of diaphyseal tibial fractures without the use of image intensifier – a study of 30 cases

Minimally invasive percutaneous plate osteosynthesis in treatment of diaphyseal tibial fractures without the use of image intensifier – a study of 30 cases - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2019.012, Indian Journal of Orthopaedics Surgery-Indian J Orthop Su

Effects of intramedullary nail removal after tibial fracture repair: A prospective study

Introduction: Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. We conducted a prospective study to investigate effects of intramedullary nail removal after tibial fracture union. Methods: Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) - 4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner–Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Results: Fifty-seven patients were followed for a mean of 8.4 (2–17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions (p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (

Results of Flexible Intramedullary Nailing in the Treatment of Tibial Diaphyseal Fractures in Children

Results of Flexible Intramedullary Nailing in the Treatment of Tibial Diaphyseal Fractures in Children

Treatment of tibial diaphyseal fractures following plateless tibial tuberosity advancement to manage cranial cruciate disease.

To report diaphyseal fractures of the proximal tibia following tibial tuberosity advancement without plate stabilisation for the management of cranial cruciate ligament rupture in dogs. Members of the British Veterinary Orthopaedic Association's online discussion forum were invited to submit revision cases of tibial diaphyseal fracture following tibial tuberosity advancement without plate fixation. Data collected included signalment, surgical revision technique, pre- and postoperative revision radiographic findings, complications and veterinary assessment. Owners were invited to complete the Liverpool Osteoarthritis in Dogs questionnaire. A total of 17 dogs were included in the study. Eleven dogs had OrthoFoam-wedge modified Maquet procedures and six had the tibial tuberosity advancement rapid procedure. Tibial tuberosity advancement was maintained in 14/17 cases. Postrevision surgery complications occurred in eight cases: minor complications in 3/17 dogs; major in 5/17 and no catastrophic complications. Surgical site infection was the most common complication (4/8). Final clinical outcome found 8/17 of dogs to have excellent, 8/17 satisfactory and 1/17 poor clinical outcome. The median Liverpool Osteoarthritis in Dogs score was 12/52 (range 2 to 28). Final outcome was 6/13 owners that were very satisfied, 2/13 owners indifferent and 5/13 owners very disappointed. This is the first case series reporting tibial diaphyseal fractures following tibial tuberosity advancement without plate stabilisation. The authors report here a wide spectrum of potential fixation strategies should one of these fractures occur.

LOCKING INTRAMEDULLARY NAIL VERSUS PLATE AND SCREWS FOR FIXATION IN TIBIAL DIAPHYSEAL FRACTURE

Diaphyseal tibial fracture is the most common fractured long bone because of it is subcutaneous position anteromedially and thinner diaphysis distally. Tibial diaphysis has poor blood supply and poor soft tissue envelope around it so it is more susceptible to infection, delay union, and non-union. For these reasons many modalities including cast and brace, external fixation, plate and screws, and locking intramedullary nail were used for treating diaphyseal tibial fracture. The aim of this study is to compare the outcome of locking intramedullary nail(LIMN) fixation versus plate and screws fixation in treating diaphyseal tibial fracture in term of operation time, early weight bearing, time to union, and complications. The study was carried out in Sulaimaniyah Teaching Hospital, Department of Orthopedics prospectively from May 2010 to July 2014 on 74 patients, 40 of them underwent surgical fixation by locking intramedullary nail (26 close method and 14 by open method), and 34 of them underwent open reduction and internal fixation by plate and screws. The outcome was assessed by clinical and radiological evaluation. The results show that young male are more affected by trauma, and the main mechanism of injury was Road Traffic Accident. Operation time was shorter among plate and screws group with a mean of 51.4±4.9 minutes, than locking intramedullary nail group with a mean of 88.5±12.5 minutes. Weight bearing(WB) time achieved earlier in the locking intramedullary nail group with a mean of 2.6±0.8 weeks than the plate and screws group with a mean of 4.2±1.4 weeks. There were no significant difference between the two groups regarding time to full weight bearing(FWB), time to union, and complications. In conclusion, Locking intramedullary nail and plate fixation are ideal option for treatment of diaphyseal tibial fractures since there were no significant differences between them in time of union and the post-operative complications.

Anterior Knee Pain after Tibial Intra-medullary Nailing: Is it Predictable?

Introduction: Intramedullary nailing has been used frequently for the treatment of tibial diaphyseal fractures. Chronic anterior knee pain has been considered the most frequent post-operative complication of this technique. We investigated the relationship between anterior knee pain and position of nail tip in proximal tibia.Methods: 103 patients were selected among patients who underwent interlocking nailing in our institution. Patients with other factors that might cause anterior knee pain were excluded. In all patients intramedullary nailing was done using transpatellar approach. The patients were evaluated in two groups, 42 patients had anterior knee pain (Grup A), whereas 61 patients did not have pain (Group B). The distance from nail tip from tibial plateau was measured on lateral radiographs. Nail prominence from anterior tibial cortex was also measured.Results: The two groups were similar with respect to gender and follow up period. Out of 42 patients who had knee pain 21 (50%) had nail tip within proximal third distance from plateau to tibial tuberosity. Twenty-four patients (42%) among knee pain group had nail prominence of more than 5mm from anterior tibial cortex followed by 12 patients (29%) within 5mm and 12 patients (29%) nail tip buried within the anterior cortex.Conclusion: A greater incidence of knee pain was found when nail was prominent more than 5mm and when it is in the proximal third distance from tibial plateau to tuberosity. Patients should be aware of high incidence of knee pain when the nail tip is placed in proximal third and prominence of more than 5mm.

Comparison of intramedullary nail and plating in treatment of diaphyseal tibial fractures with intact fibulae: A randomized controlled trial.

Background:Tibial fracture without concomitant fibular fracture is an injury that has long attracted notice for the fact that it sometimes heals cleanly, other times causes various problems when the bone does not heal, or misaligns. In this randomized clinical trial, we assessed two treatment modalities plating and intramedullary nailing for treatment of closed, noncomminuted tibial fractures with intact fibulae.Materials and Methods:During the three year period, 1470 patients with leg fractures were treated and out of which, 114 were eligible to enter the study. Of the eligible patients, 73 were recruited to enter the trial, and ultimately 69 of these were followed for at least one year. The patients were randomized into two groups, one of which was treated by plating of the fracture, the other group by intramedullary nailing, both of which are standard surgical procedures. The primary variables that influenced the outcome of the procedures in both treatments were the duration of surgery, the amount of bleeding, the time to union, the need to repeat surgery to achieve union, the need to remove a device, and patients’ complaints about pain or discomfort in the limb.Results:One case of nonunion occurred in the group treated with intramedullary nailing and one of the patients in this group developed late, deep infection in the screws location, which was resolved by screw removal (P = 0.285 and P = 0.478, respectively). In both groups the tibial fractures achieved union in about 4 months, though the intramedullary group underwent more operations to achieve union (dynamization was performed in 4 patients, representing 12.1% of the patients in this group, P = 0.047). During the followup period, the incidence of implant removal (after union) was not statistically significant between the two groups: two patients (6.1%) in the intramedullary group and four patients (11.1%) in the plate group (P = 0.675) had implants removed. Of the other studied variables, the difference between the two groups was statistically significant only with regard to patients’ complaints of pain in the limb and the number of individuals with knee pain (in both cases, P = 0.001). In the intramedullary group, 18 patients had no complaints (54.4%) and 13 complained of knee pain (39.4%), while in the plate group 29 had no complaints (80.6%).Conclusion:Based upon the findings of the present study, both the methods studied are suitable treatments for closed noncomminuted isolated tibial fractures, but the patients in whom intramedullary nails are used are more likely to require additional surgeries to achieve union, and probably will have more complaints of pain in their limbs or knees.

Locked META intramedullary nailing fixation for tibial fractures via a suprapatellar approach.

Background:Intramedullary nailing is an effective approach for treatment of diaphyseal tibial fractures. However, infrapatellar intramedullary nailing can easily cause angulation and rotation displacement at the fracture ends and increase risk of postoperative infection. Intramedullary nailing via the suprapatellar approach was proved with good reduction and fixation. We used locked intramedullary nailing for the treatment of tibial fractures via a suprapatellar approach in this study.Materials and Methods:23 patients undergoing tibial fractures fixation by locked META intramedullary nailing via a suprapatellar approach were enrolled between June 2012 and October 2013. There were 18 males and 5 females. The average age was 35.5 years (range 18-60 years). The intraoperative data including operative time and blood loss and postoperative data consisting of hospital stays, fluoroscopy time, fracture healing time and complications were all recorded.Results:The average operative time, blood loss, fluoroscopy time and hospital stay were 78.2 ± 9.1 min, 90.4 ± 23.4 mL, 38.5 ± 6.5 s and 11 ± 3.4 days respectively. The mean followup period in all the patients was 15.5 months. Callus appeared in the patients at average 8 weeks after surgery. The mean knee and ankle range of motion were significantly improved at the last followup (P < 0.05). The average Hospital for Special Surgery and Olerud–Molander scores was 92 ± 4.3 points and 93.6 ± 3.9 points, respectively. No complications were observed.Conclusion:Locked META intramedullary nail fixation via a suprapatellar approach is safe and effective for patients suffering from tibial fractures and earlier functional recovery.

Results in the Treatment of Tibial Diaphyseal Fractures with Expandable Intramedullary Nails

Results in the Treatment of Tibial Diaphyseal Fractures with Expandable Intramedullary Nails

Dilemmas in the treatment of tibial diaphyseal fractures

Tibial fractures accompanied by radius fractures at typical sites are the most common type of fractures. The study is aimed at using the examined sample to make an efficient and economically acceptable choice in the treatment of tibial diaphyseal fractures. The series comprises a retrospective and prospective study of the treatment of 131 fresh tibial fractures: 31 in women (23.66%) and 100 in men (76.34%) of the average age of 37.89. Nineteen patients (14.50%) were treated conservatively and 112 (85.50%) surgically: 22 (16.79%) with anti-rotation intramedullary nails, 74 (56.49%) with Mitkovic external fixator type M20, and 16 (12.21%) with locking compression plate. General anaesthesia was used in 46 patients (35.11%), while spinal anaesthesia was used in 85 of them (64.89%). According to the Karlstrom-Olerud scoring system, the treatment results were as follows: for the 22 tibiae treated with anti-rotation intramedullary nails: in 15 (68.18%) the results were excellent, in 3 (13.64%) they were good and in 4 (18.18%) they were poor. As for the results for the 74 tibiae treated with Mitkovic external fixator type M20, they were as follows: in 62 (83.78%) excellent, in 9 (12.16%) good, and in 3 (4.05%) they were poor. The results for the 16 patients treated with locking compression plate were excellent in 10 (62.50%), good in 2 (12.50%) and poor in 4 patients (25.00%). The treatment results for the 19 tibiae treated with plaster cast were excellent in 12 patients (63.16%), good in 2 (10.53%) and poor in 5 (26.32%). The definite results for the 131 fractured tibiae treated with the aforementioned techniques were as follows: excellent in 99 (75.57%), good in 17 (12.98%) and poor in 15 patients (11.45%). There is a variety of controversial positions concerning the treatment of the tibial diaphysis. On the basis of the results of surgical treatment for the given series, the number of surgical interventions, the price of osteosynthetic material, my preferences in treating tibial diaphyseal fractures would be as follows: Mitkovic external fixator type M20, anti-rotation intramedullary nails and locking compression plate. Conservative treatment is indicated when the X-ray examination confirms that the fragments have a position acceptable for conservative treatment with plaster cast.

A Clinical Study For Management Of Tibial Diaphyseal Fractures In Adults With Locking Compression Plate Using Mippo Technique

Background: The tibia is the most commonly fractured bone of all the long bones in the body. In-spite of advances in treatment, fractures of tibia still pose a challenge to the orthopaedic surgeon as to their best method of management. Vulnerability of soft tissues and increased incidence of open fractures further complicates these fractures. Minimally invasive percutaneous plate osteosynthesis is one of the modalities of treatment of tibial diaphyseal fractures which causes minimal disturbance of blood supply and preserves the soft tissues around the fracture site. The aim of our study is to show the results of treatment of tibial diaphyseal fractures using MIPPO technique. Patients and methods: Our study included fifty patients with tibial diaphyseal fractures treated with locking compression plate using MIPPO technique. Fourteen patients had associated skeletal injuries. Ten patients had a type one open fracture. Results: All the fractures united at an average of 22.25 weeks. Forty patients (80%) were pain free, six patients (12%) had occasional pain (no limitation of activities) and four patients (8%) had persistent pain with limitation of daily activities. 46 (88%) had excellent or good results and 4 (8%) had poor results. 4 (8%) patients had delayed union and 1(2%) patient developed superficial skin infection, 6 patients (12%) had a palpable hardware and 3 patients (6%) had ankle stiffness.Conclusion: Minimally invasive plate osteosynthesis is a good and safe technique for treatment of tibial diaphyseal fractures providing fracture healing, rapid functional recovery, with minimal soft tissue damage and preservation of blood supply. It is a reliable approach for the management of tibial diaphyseal fractures with proper indications.

Treatment of 103 displaced tibial diaphyseal fractures with a radiolucent unilateral external fixator

The authors report their experience in the treatment of the diaphyseal tibial fractures, using the unilateral radiolucent External Fixator (EF) XCaliber. A total of 100 patients (average age 35 years, range 16-76) with 103 displaced diaphyseal tibial fractures were treated with the XCaliber. There were 59 type A fractures, 35 type B, and 9 type C (according to the AO classification) and 35 were open fractures. During the last assessment, patients were evaluated for level of pain, ability to perform weight-bearing activities, and number of residual deformities. The average follow-up time was 24 months, 3 patients (4 fractures) were excluded for final assessment and 1 patient moved abroad. Of the remaining 98 fractures, 83 (84.7%) healed with a single operation in a mean 21 weeks (SD 3.97; 12-38 weeks), 10 fractures had a delayed union and 5 fractures proceeded to a non-union. There were 13 complications. Among them, a loss of reduction was observed in 3 cases due to overload of the EF, in 3 cases, deep pin track infections were observed and 2 fractures healed with more than 1 cm of shortening. The results are encouraging, since both complex and open fractures were included in this study. The XCaliber was shown to be a valid unilateral external fixator, combining the advantage of radiolucency during application and radioscopic follow-up with a stable and flexible fracture fixation. This represents the first report in the literature specifically examining treatment of tibial diaphyseal fractures with a radiolucent external fixator.

Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions.

Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures

Background:We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures.Materials and Methods:One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union.Results:The follow-up period averaged 15 months (range, 6–26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury.Conclusion:Unreamed distally locked dynamic tibial nailing (modified Kuntscher nail/Daga nail) can produce excellent clinical results for diaphyseal tibial fractures. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.

Physiopathology and Treatment of Tibial Diaphyseal Fractures

Physiopathology and Treatment of Tibial Diaphyseal Fractures

COMPARATIVE STUDY OF THE LOCKED INTRAMEDULLARY NAIL AND ENDER PINS IN THE TREATMENT OF TIBIAL DIAPHYSEAL FRACTURES

To compare the locked, unreamed intramedullary nail with Ender pins in the treatment of open Gustilo grade I or II or closed tibial diaphyseal fractures of type A, B, or C2 of the AO classification. Forty-four patients with unilateral tibial diaphyseal fractures were treated with intramedullary nails or Ender pins. Twenty patients were treated with an unreamed intramedullary nail with access via the patellar tendon with static locking. Twenty-four patients were treated with Ender pins introduced medially and laterally with respect to the tuberosity of the tibia. The main parameters analyzed were type of reduction, complications, union rate, deformities, joint mobility, pain, gait, effort capacity, presence of neurovascular disorders, and complaints related to the synthesis material. During 1 year of follow-up, the fractures of 90.0% of the patients with intramedullary nails and 95.7% of patients with Ender pins healed within an average of 21.5 weeks and 20.9 weeks, respectively. The significant findings were as follows: patients treated with Ender pins had less mobility of the subtalar joint; patients treated with intramedullary nails were more likely to have pain in the knee; both groups showed shortening of the tibia at the end of 1 year of treatment. The two methods are similar in the treatment of type A, B, and C2 tibial diaphyseal fractures.

Internal fixation with percutaneous plate for treatment of tibial diaphyseal fractures

骨折内固定治疗的目的是为骨折提供一个愈合的力学和生物学环境,解决好骨折端的稳定和血运,使骨折尽快愈合.也是内固定技术发展200多年来始终探寻的目标.2003年5月～2005年5月,我们收治各种创伤造成的闭合性胫骨干骨折共23例(合并腓骨骨折5例),采用经皮钢板内固定治疗,取得良好疗效,报告如下。