[Indications for surgical management of lower leg fractures]

Abstract

A follow-up series of 324 lower leg fractures treated between 1980 and 1985 in a regional hospital showed overall good results. Besides a non-union-rate of 0% there were also low values for infection (3.7%), re-fracture (2.16%), delayed healing (4.63%) and thrombosis (3.42%). Many reasons are dealing with that. First of all, most of our patients were young, active people, who sustained their injuries during ski-accidents with a high amount of torsional-type lesions (A1, B1, C1; Johner/Wruhs-scheme). The second important point was, to use a simple, quick and safe method with the possibility of a short hospital stay and good final outcome, managing the high frequency of victims, admitting the trauma unit in the late afternoon after closure of ski-lifts. Finally, one has to realize, that most of our patients had been treated by one surgeon, who has a lot of experience with the aforementioned methods. We can state finally, that percutaneous cerclage-wires (Götzes method) will be used for spiral fractures, occurring in the second to fourthfifth, in future, too. Bending-type fractures with one or more butterfly-fragments (B2, B3) and segmental fractures (C2), should be treated by interlocking nailing. Only fractures with severe closed soft tissue injuries or open fractures (grade II-III-Tscherne), will be managed by an external frame. Compression plates should only be used for fractures in the first or fifth fifth with articular lesions.