Journal of Musculoskeletal Trauma

Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis: Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha; J Korean Fract Soc 2020;33(3):142-147. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.142

Abstract PDF: Purpose
This study examined the clinical outcomes after the treatment of a tibia segmental fracture with intramedullary nailing (IM nailing) and minimal invasive plate osteosynthesis (MIPO).
Materials and Methods
From July 2012 to December 2017, 14 out of 17 cases from a treatment cohort of 32 cases of AO type 42 C2 tibia segmental fractures with IM nailing and MIPO were studied retrospectively. Periodic radiographs were used to evaluate the presence of union, union time, and radiographic evaluation of bony union (varus-valgus deformity, anteroposterior angular deformity, shortening). To evaluate the postoperative clinical function, modified Rasmussen’s system was used for proximal fractures, and the American Orthopaedic Foot and Ankle Society functional score was used for distal fractures.
Results
Bony union was achieved in all 14 cases, and the average union time was 26 weeks. In one case of soil contamination, there were no other complications other than simple debridement after a soft tissue infection. The mean varus was two degrees; the mean anteroposterior angular deformity was three degrees of anterior oblique; the mean length shortening was 5 mm (2-9 mm). The mean functional score of the knee joint with the Modified Rasmussen’s system measured for the postoperative clinical function was relatively good (excellent 9, good 4, fair 1, and poor 0). The results of the Molander and Olerud Functional scores of the ankle joints were also good (excellent 8, good 3, fair 2, poor 0).
Conclusion
The treatment of tibia segmental fractures with IM nailing and MIPO can effectively reduce the gap of fracture sites. Hence, it is possible to increase the bony union probability and obtain relatively satisfactory alignment. Overall, the treatment of tibia segmental fractures with IM nailing and minimally invasive plate osteosynthesis appears to be a useful treatment, considering the preservation of the soft tissue and the alignment of the tibia.

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Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures: Sang Soo Park, Jun Young Lee, Sang Ho Ha, Sung Hae Park; J Korean Fract Soc 2013;26(4):275-283. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.275

PURPOSE
To evaluate the radiological results and complications of interlocking intramedullary nailing for segmental tibia fractures.
MATERIALS AND METHODS
Twenty-six patients (26 cases) who underwent interlocking intramedullary nailing for segmental tibia fractures between January 2003 and May 2011 were followed for more than one year. We evaluated the complications and statistically analyzed the factors influencing bone union, including open fracture, fracture site, reaming, postoperative angulation, and postoperative fracture gap.
RESULTS
Nineteen cases (73%) achieved bone union with one operation at an average of 7 months (range, 5 to 11). Seven cases had secondary procedures before achieving union. Complications included 7 cases of nonunion, 3 cases of incomplete peroneal nerve injury, 2 cases of superficial infection, 1 case of compartment syndrome. Factors showing statistically significant differences were open fracture, postoperative angulation, and postoperative fracture gap. Factors showing no statistically significant difference were fracture site and reaming.
CONCLUSION
Nonunion is the most common complication in interlocking intramedullary nailing for segmental tibia fractures. To minimize this complication, comprehension of surgical techniques to reduce anatomically and careful evaluation of the fracture are required.

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Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha
Journal of the Korean Fracture Society.2020; 33(3): 142. CrossRef

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Clinical Outcomes of the Tibia Segmental Fractures Treated by Intramedullary Nail Using Various Reduction Techniques: Oog Jin Shon, Ji Hoon Shin, Chul Wung Ha; J Korean Fract Soc 2013;26(1):50-55. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.50

Abstract PDF: PURPOSE
We evaluated the clinical outcomes of tibia segmental fractures treated by intramedullary nailing using various reduction techniques.
MATERIALS AND METHODS
From January 2003 to June 2009, 18 segmental tibial fracture patients treated by intramedullary nail were enrolled with a minimum 12-month follow-up. The mean follow-up was 38 months (range 15-72). According to the AO classification, the fractures were types 42C2.1, 42C2.2, and 42C2.3 in four, ten, and four patients, respectively. Ten fractures were closed and eight were open. We used various techniques for reduction during operation and investigated bone union time and complication (non-union, malunion etc.).
RESULTS
Bone grafting was performed in three patients. Complete union was achieved in all patients. The mean time for union was 16.3 weeks (range 12-21), except in three delayed union patients. All radiological evaluations showed good alignment (less than 5 degree) except in two patients; and the mean deformity angle was 2.2 degree. Knee range of motion (ROM) was 129 degree, and ankle ROM was 68 degree. Local wound infection occurred in two patients.
CONCLUSION
Intramedullary nailing is a successful method in the acute management of segmental tibial fractures, if accompanied by appropriate reduction technique.

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Ipsilateral Femoral Segmental and Tibial Fractures : A Case Report: Oog Jin Sohn, Chul Hyun Park, Sang Keun Bae; J Korean Fract Soc 2009;22(3):193-196. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.193

Abstract PDF

The ipsilateral femoral segmental and tibial fractures seldom occur such as traffic accidents needed high energy mechanisms. For these fractures, surgical stabilization and early mobilization of joint produce can be the best clinical outcomes. We have experienced a case of ipsilateral femoral segmental and tibial fracture and gained good clinical results with surgical treatment. We have reported here on this case and included a review of the relevant literature.

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Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha
Journal of the Korean Fracture Society.2020; 33(3): 142. CrossRef

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Retrograde Intramedullary Nailing or the Treatment of Segmental Femoral Shaft Fracture Including Distal Part: Jong Ho Yoon, Byung Woo Ahn, Chong Kwan Kim, Jin Woo Jin, Ji Hoon Lee, Hyun Ku Cho, Joo Hyun Lee; J Korean Fract Soc 2009;22(3):145-151. Published online July 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.3.145

Abstract PDF

PURPOSE
To evaluate the usefulness of the retrograde intramedullary nailing for the treatment of segmental femoral shaft fracture including distal part.
MATERIALS AND METHODS
We reviewed 15 patients of segmental femoral fracture, who had treated with retrograde intramedullary nailing and followed-up more than 1 year from January 2003 to October 2007. There were 10 men, 5 women, and the mean age was 45 years old. There were associated fracture in 10 cases. We evaluate the time for union, non-union and malunion by radiologic finding and functional assessment by Sanders' criteria.
RESULTS
The mean time of union was 21 weeks. There was one delayed union in proximal fracture site. There was no shortening more than 1.5 cm, no angular deformity more than 10 degrees, no postoperative infection or instability. According to Sanders' criteria, there were excellent clinical results in 9 cases, good results in 5 cases and fair result in 1 case.
CONCLUSION
The retrograde intramedullary nailing can be a useful method for treatment of segmental femoral shaft fracture including distal part.

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef

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Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture: Jeung Tak Suh, Sang Jin Cheon, Young Gyun Kim, Jung Sub Lee, Choon Key Lee; J Korean Fract Soc 2005;18(3):256-263. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.256

Abstract PDF: PURPOSE
To evaluate the outcomes of twenty-six cases of segmental tibia fracture that were treated by closed interlocking intramedullary nailing. MATERIAL AND METHODS: All cases were followed up for at least 1 year (average 14.3 months). Clinical results were evaluated by Klemm & Borner's scale. We analyzed the average range of the motion of the ankle and knee joint, atrophy of quadriceps muscle and angular deformity at the last follow up. We evaluated complications (new fracture of the tibia, infection, compartment syndrome, nonunion, delayed union, angular deformity and pain of ankle and knee joint).
RESULTS
Results were excellent in 4 cases (15.4%), good in 18 cases (69.2%), fair in 3 cases (11.5%), and poor in 1 case (3.9%). Union was obtained in 25 cases (96.1%) over an average period of 23.3 weeks. Nine cases showed intra-operative or post-operative complications: new fracture of the proximal tibia on the posteromedial side (2 cases), local infection at an entry point (2 cases), compartment syndrome (1 case), deep infection (1 case), and delayed union (3 cases). At the last follow up, angular deformity was found in 4 cases (mean of all deformities, 6 degrees): 3 cases at the proximal fracture site (2 cases of valgus deformity: 5 and 8 degrees and 1 case of varus deformity: 7 degrees) and the other case in the distal fracture site (valgus 5 degrees). Average postoperative range of motion of the knee joint was 123.7 degrees (80~135 degrees). Knee pain or limited motion occurred in 4 cases. The average range of the motion of the ankle joint was 68.1 degrees (60~70 degrees). Limited motion occurred in 4 cases (average, 10 degrees) but no case showed ankle pain.
CONCLUSION
Closed interlocking intramedullary nailing for segmental tibia fracture often results in complications. To minimize these complications, comprehensive evaluation of the fracture, and careful surgical treatment are required.

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Treatment of the Segmental Fractures of Tibia with Ilizarov External Fixation: Kwang Soon Song, Chul Hyung Kang, Byung Woo Min, Si Hyun Jeon, Ki Chul Bae, In Kyu Kim; J Korean Fract Soc 2004;17(1):25-31. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.25

Abstract PDF: PURPOSE
To emphasis an effectiveness of the Ilizarov circular external fixator in treatment of the complicated segmental fractures of the tibia MATERIALS AND METHODS: We had analyzed 15 cases in 14 persons, treated from November 1993 to March 2000. We analyzed several considering factors including age, etiology, type of fracture, number of the segmentation, associated injuries, open or closed fracture, healing time, additional bone graft, clinical results and complications.
RESULTS
The mean period of follow up was 22 months. The mean age was 45 years. The etiology was traffic accident in 13 persons. Open fracture were 11 cases (73%). Associated injuries were noted in 8 persons (53%). The number of segmentation were three segments in 9 cases (60%) and four segments in 6 cases (40%). Additional manipulations after first application were needed in 10 cases (67%). Bone graft were performed in 5 fracture site (9.8%), proximal fracture site in two and distal in two, middle in one. Mean period of application of external fixator for healing was 8.1 Months. Procedures for soft tissue injuries performed in 3 cases including two split thickness skin graft and distant flap surgery. The results were graded as excellent in 5 cases, good in 2 cases, fair in 1 cases, poor in 7 cases. Limitation of motion in ankle joint was major cause of poor results CONCLUSION: We considered that ilizarov circular external fixator is one of effective treatment modality in treatment of the complicated segmental tibia fractures.

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Treatment of Segmental Fractures Associated with Periarticular Fracture of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Ju Hong Lee, Jun Mo Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 2003;16(4):504-510. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.504

Abstract PDF: PURPOSE
We analyzed the results and complications of the treatment of segmental fractures of the tibia associated with periarticular fracture by using Ilizarov external fixator.
MATERIALS AND METHODS
We reviewed 17 patients of segmental fractures of the tibia were treated by Ilizarov external fixator and were followed for a minimum one year. There were twelve closed fractures, three type 3A, and two type 3B open fractures. According to Melis classification, there were five type I, four type II, and eight type III. All closed fractures were reduced and fixed with Ilizarov external fixator within seven days. Open fractures were performed immediate wound irrigation and radical debridement and fixed with Ilizarov external fixator. Autogenous iliac bone graft was done in five severe comminuted fractures. Average time in bone graft was 7.5 weeks after operation. We analyzed bony union time according to configuration and site of the fractures, results of the treatment, and complications. The functional outome was assessed with rating system of Tucker.
RESULTS
In all cases, bony union was obtained, and average union time was 20.5 weeks. According to modified Melis classification, our results showed no difference between each criteria with respect to bony union and there was no difference bony union time between proximal and distal fracture site. There were two leg-length discrepancy less than 2 cm, one partial ankylosis of the knee joint, and ten pin tract infections. The functional results was excellent in 11 cases, good in 5 cases, and fair in one case.
CONCLUSION
Ilizarov external fixator can be useful method for the treatment of segmental fractures of the tibia associated with juxtaarticular fracture in respect of bony union and functional results.

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Interlocking Nailing in Segmental Tibial Fractures: The Problems of the Fractures involving Proximal Portion: Ki Soo Kim, June Young Song, Kwang Soo Shon, Joon Han Kim; J Korean Soc Fract 2000;13(4):912-920. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.912

Abstract PDF: PURPOSE
To analyze the clinical features and treatment results of the tibial segmental fractures with the interlocking nailing. To compare the results between the segmental fractures with (Group I) or without (Group II) involving proximal portion of the tibia.
MATERIALS AND METHODS
We analyzed 16 patients, 16 cases of the tibial segmental fractures treated with the interlocking nailing between April 1993 and November 1998.
RESULTS
We obtained solid bone union for all cases and relatively good clinical results. The average bone union time was 20.6 weeks. The functional results were excellent in 7 cases, good in 6 cases and fair in 3 cases. There were 8 cases of malunion. The comparison between Group I and Group II revealed no remarkable differences for bone union time, functional results and complications. But the tendency of the malunion was more higher in Group I.
CONCLUSION
For segmental tibial fractures, interlocking nailing showed good clinical results. We propose that open reduction and internal fixation should be done before interlocking nailing of the fractures involving proximal portion of the tibia.

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Interlocking Intramedullary Nailing for the Treatment of Segmental Tibial Shaft Fractures: Kyung Jin Song, Young Keun Lee, Jeong Yeul Kim, Byung Yun Hwang; J Korean Soc Fract 1999;12(1):69-75. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.69

Abstract PDF: The treatment of segmental tibial shaft fractures poses many problems because of the serious damage to the surrounding soft tissue that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like non-union, delayed union, malunion, and infection We studied to evaluate the treatement results of interlocking intramedullary nailing for the segmental tibial shaft fractures. Twenty-two cases of segmental tibial shaft fractures were reviewed and we analyzed the results of surgical treatement in the viewpoint of bony union times, complication and its final outcome. The range of follow-up was 12 months to 68 months with mean 38 months follow-up. Most of the patients were between forty and sixty years, and average age was 47 years. Associated injury was incurred in nineteen cases with various musculoskeletal symptoms and signs. According to Meils classification, 8 were Type I, 1 was Type II and 3 were Type IV of the 12 closed fractures. Of the 10 open fractures, 4 were Type, 2 were Type II, 3 were Type IV, and 1 demonstrated multisegmental fractures. All of the closed fractures were united well except only one infected nonunion. The average time to union was 21.6 weeks with range from 16 to 26 weeks. The healing was tlowest in Type IV and fastest in Type I fractures. There was no significant difference in the healing time between the distal and proximal fractures. Of the 10 open fractures, each one of open type I fracture and open type II fractures did not united because of infected nonunion. The average time to union was 26.4 weeks with range from 16 to 38 weeks for the remaining 8 open fractures. The healing was slowest in Type IV and fastest in Type I fractures. There were 3 cases of infected nonunion, 1 case of delayed union of the proximal fracture and 1 case of valgus deformity of distal fracture. The infection was controlled and bone union obtained with removal of the nail and reaming, curettage and antibiotic bead wire, and plating with bone graft. We recommand that wherever poslible, interlocking intramedullary nailing can be used for the closed or open type I and II segmental tibial shaft fractures. And a high rate of union and a low rate of complication can be expected with this treatment modality.

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Intramedullary Nailing Treatment for Segmental TibialFractures: In Heon Park, Kee Byoung Lee, Kyung Won Song, Jin Young Lee, Eung Joo Lee, Byung Koo Jooe; J Korean Soc Fract 1998;11(3):546-551. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.546

Abstract PDF: Fracture of the tibia is the most common fracture of the long bone and due to its anatomical property, significantly high rate of complication has been reported during and after treatment. Various ways of surgical treatment have been tried with reasonable satisfaction. Recently, closed intramedullary nailing under the image intensifier has been widely performed with good results. However, segmental tibial fractures are more difficult than ordinary tibial shaft fracture in terms of reduction and fixation. Its treatment has been rather challenging for average orthopedic trauma surgeons. Particularly, segmental tibial fractures are commonly combined with extensive soft tissue injury, comminution as well as displacement resulted in poor blood supply especially in its middle segment. In this paper we are reporting our experience with intramedullary nailing treatment for 13 segmental tibial fractures in 13 patients. 13 cases with segmental fracture of tibia were reviewed, which were treated at the Deparment of Orthopaedic Surgery, Kang-Dong Sacred Hospital of Hallym University for 6 years from January 1990 to December 1996 with more than 1 year follow up period. All cases were caused by traffic accident and four were open fractures. Patients were 19-60 years of age (average 44) with male to female ratio of 1.6:1. The fractures were closely reduced and intramedullary nailed under the image intensifier control. Two cases were added with limited skin opening of the displaced fragments for reduction. Seven cases were reenforced an additional immobilization such as long leg splint or cast or externl fixator postoperatively. Melis type I fractures were most frequent in our series. All fractures were healed within a 1 year and average union period was 167 days (proximal fracture-144 days, distal fracture-190 days). Complications were a case of chronic osteomyelitis and one deep vein thrombosis and 4 case of delayed union, which were treated by reoperation with bone grafts. Displacing most proximal fragment was most troublesome to manage during and after operation. We tried intracortical screws fixation between proximal and middle segments with satisfactory bony union without displacement for a case. Carefully planned intramedullary nailing with or without some modification of the most proximal and shoryt segment seems to be recommendable way of treatment for the most segmental fractures of the tibia.

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Tibial Segmental Fracture Treated with Interlocking Intramedullary Nail: Churl Hong Chun, Byung Chang Lee, Gyu Taec Hwang, Soon Gu Kwon, Han Sol Lee; J Korean Soc Fract 1997;10(3):534-540. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.534

Abstract PDF

The orthopaedic surgeon experiences the difficulties of treating segmental tibial fractures by internal fixation and accompanying complications. OBJECT : The purpose of this study has been to review the useful treatment of 21 interlocking nails in the tibial segmental fracture, to investigate the union rate related to fracture types and to analyze the complications related to it. METERIAL and METHOD : Between November 1988 and August 1995, the authors treated tibial segmental fractures with interlocking intramedullary nail and analyzed 21 cases with followed up of more than 1 year. Injury mechanism were caused by traffic accident in which high velocity accounted for 17 cases. 11 cases of segmental tibial fracture were closed, and 10 cases were open. 6 cases of open fracture were open type 1, and 4 cases were open type II. We treated 21 fractures with unlearned intramedullary nail of 7 cases and limited reamed intramedullary nail of 14 cases.
RESULT
: Callus formation and consolidation were faster at the posterolateral aspect of the tibia than in anteromedial aspect. Radiologically complete union was faster in proximal portion at average 26.8 weeks than distal portion of segmental fracture at average 35.6 weeks. Complications included 2 cases of nonunion, 1 infection, 2 screw breakage and 2 ankle joint stiffness.
CONCLUSION
: We achieved excellent results using interlocking intramedullary nail by limited reaming or unlearned methoo in the tibial segmental fracture even though the injury was caused by high-velocity external force.

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Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures
Sang Soo Park, Jun-Young Lee, Sang-Ho Ha, Sung-Hae Park
Journal of the Korean Fracture Society.2013; 26(4): 275. CrossRef

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A Traumatic Anterior Hip Dislocation Associated Ipsilateral Femoral Shaft Segmental Fracture : Case Report: Chang Soo Kang, Young Rae Cho; J Korean Soc Fract 1997;10(3):516-521. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.516

Abstract PDF: Traumatic hip dislocation associated with ipsilateral femur shaft fracture is a very rare injury and often results from high velocity injury such as traffic accidents or fall from a height. This combined injury was first documented by Sir Ashley Cooper in 1823. Wiltberger, Mitchell and Hedrick estimated its incidence at one out of 100,000 cases of fractured femoral shaft. Until 1978 there have been only 3 cases were reported of anterior hip dislocation with ipsilateral femoral shaft fracture in the literature. We have recently had the opportunity to manage the patient with anterior hip dislocation with ipsilateral femoral shaft segmental fracture and contralateral acetabular fracture.

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Locked Intramedullary Nailing of Tibial Segmental Fractures: Bu Hwan Kim, Jong In Yim, Hee Yeong Chung, Joon Young Park; J Korean Soc Fract 1995;8(3):557-565. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.557

Abstract PDF: Recently closed interlocting intramedullary nailing under image intensifier has been widely used in the treatment of segmental fracture of long bone and good results have been reported. Twenty-six segmental fractures of tibia were treated with interlocking intramedullary nailing from Mar. 1989 to Feb. 1993 at Dae-Dong General Hospital and all cases were followed up more than 18 months. In this paper we are reporting the results of twenty-six segmental tibial fracture treatment. 1. Seventeen patients were male and 7 patients were female. 2. Eighteen cases(69.2%) were caused by traffic accident and ipsilateral fibular fractures were the most common associated injury. 3. Most common type of fractures were Melis type II(10 cases 38.4fo), proximal fracture lies in the middle third of the shaft and the distal fracture lies in the lower third. 4. Average union time in closed fractures was 23.0 weeks and 29.5 weeks in open fracture with average 28.5 weeks.

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