Shaft Repair Therapy Treatment
Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15° of flexion and the ankle flexed at 90°. Admission to the hospital may also be necessary to control pain and to monitor closely for compartment syndrome, Closed fractures with minimal displacement or stable reduction may be treated non operatively with a long leg cast, but cast application should be delayed for 3-5 days to allow early swelling to diminish.
The cast should extend from the midthigh to the metatarsal heads, with the ankle at 90° of flexion and the knee extended. The cast increases tibial stability and can decrease pain and swelling, Early ambulation with weight-bearing as tolerated should be encouraged. Tibial shaft fractures treated with casting must be monitored closely with frequent radiographs to ensure that the fracture has maintained adequate alignment, Adequate callus formation generally takes 6-8 weeks before cast therapy can be discontinued, Despite proper casting techniques and adequate follow-up, not all nonoperatively treated tibial shaft fractures heal successfully, In addition, 6 weeks without knee motion often results in a stiff joint. In fact, Kyro et al found that 53% of patients reported a fair or poor result using long leg casts to treat tibial shaft fractures, This and many other studies have shown that simply putting a tibial fracture in a long leg cast may lead to increased joint stiffness, some difficulty ambulating, and increased union times.
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