Abstract
Fractures of the tibia are generally considered major injuries because delayed and nonunions are frequent, angulatory deformities are common, the rate of infection is greater than in most other bones and the period of incapacitation and reha-bilitation is lengthy. It should be obvious that one single treatment is not applicable to all types of fractures, at all times, and in all circumstances. It is the surgeon’s responsibility to have adequate knowledge of the various systems and techniques available and to institute the most appropriate procedure required by the circumstances. Open reduction and internal fixation of fractures is a proven and acceptable method of treatment of many fractures of long bones and has served countless patients over the decades. It must be understood, however, that the internal fixation of a fracture constitutes a violation of the natural biologic process of osteogenesis and that it interferes with normal healing. There is considerable evidence in the literature that the placement of a plate or the insertion of a nail delays the healing of a fracture. The disruption of the normal healing process from internal or rigid fixation, as well as external immobilization of fractures, is discussed in Chapter 2