Fracture of the tibial diaphysis: epidemiology, management and outcomes

Introduction
Tibial shaft fractures represent 2% of all fractures. A high percentage of them present as open fractures possessing a higher incidence of local complications. An accurate description of the epidemiology and outcomes of these injuries is lacking and often based on small or outdated studies.

Aims
This work aims to provide an accurate description of the epidemiology and demographics of tibial shaft fractures in the city of Leeds over a 12-year period from 2008 to 2019. It will also describe the modern orthopaedic management of these injuries and provide accurate rates of major complications including infection, delayed union and non union.

Methods
A retrospective cross-sectional study of all adults (18 years and older) who presented to a major Trauma center with tibial shaft fractures in the city of Leeds from January 2008 to December 2019. Descriptive statistics were employed to report on empirical rates of major complications and basic inferential statistics were used to compare treatment modalities against these outcomes.

Results
A total of 1220 tibial shaft fractures were recorded over 12 years. The incidence has risen from 8.08 per 100,000 and year in 2008 to 13.1 per 100,000, a 60% increase. The proportion of elderly patients found to be increasing more steeply than other age groups and these patients are largely female. Non-unions rates have been slowly reducing over time with an overall rate of 6.6% (4.2% in closed fractures and 11.7% in open fractures). The rate of other major complications noted to be static. Plate osteosynthesis confers the highest rate of non-union, deep infection and osteomyelitis in both open and closed injuries.

Conclusion
Over the past decade, tibial fractures are increasing in both number and complexity, more so in the older population. Plate osteosynthesis confers higher major complication rates compared to other treatment modalities.