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Luke Turley Department of Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland

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Ian Barry Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia

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Eoin Sheehan Department of Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland

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shaft, over 15% of all tibial shaft fractures are classified as open ( 1 ). This makes open tibial diaphyseal fractures the most common, comprising 44.7% of all open long bone fractures ( 3 ). These fractures are most commonly the result of high

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Vanessa Morello Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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Axel Gamulin Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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occurrence in tibial plateau fractures reaches 12% and even 53% in higher-energy patterns ( 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). In tibial shaft fractures, ACS occurrence reaches 11.5% ( 10

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Abdel Rahim Elniel Leeds Teaching Hospitals Trust, UK

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Peter V. Giannoudis Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, UK

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therefore severity. Table 3. Recent studies on the clinical outcomes of Gustilo type III tibial shaft fractures Study n IM nail Union time (weeks) Infection (n (%)) Malunion (n (%)) Re-operation Naique 2006 48 26

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Signe Steenstrup Jensen Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

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Niels Martin Jensen Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark

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Per Hviid Gundtoft Department of Orthopedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark

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Søren Kold Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark

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Robert Zura Department of Orthopedic Surgery, Louisiana State University Medical Center, New Orleans, Louisiana, USA

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Bjarke Viberg Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark

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.3928/0147-7447-19840601-14 ) 16. Burrus MT Werner BC Yarboro SR . Obesity is associated with increased postoperative complications after operative management of tibial shaft fractures . Injury 2016 47 465 – 470 . ( https://doi.org/10.1016/j.injury.2015.10.026 ) 17

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Josep Muñoz Vives Hospital Nostra Senyora de Meritxell, Andorra, Spain

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Jean-Christophe Bel Hospices Civils de Lyon, Lyon, France

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Arantxa Capel Agundez Hospital Universitario 12 de Octubre, Madrid, Spain

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Francisco Chana Rodríguez Hospital General Universitario Gregorio Marañón, Madrid, Spain

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José Palomo Traver Hospital General de Castelló, Castelló de la Plana, Spain

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Morten Schultz-Larsen Odense Universitetshospita, Odense, Denmark

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Theodoros Tosounidis Leeds General Infirmary, Leeds, UK

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tibial shaft fracture and type II c) (9%) is a fracture of the tibia plateau and articular fracture of the distal femur. 2 Fig. 1 Fraser classification of the floating knee. Initial management The floating knee is much more than a

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Christos Garnavos Orthopaedic and Trauma Department, ‘Evangelismos’ General Hospital, Athens, Greece

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work is attributed. References 1. Lang GJ Cohen BE Bosse MJ Kellam JF . Proximal third tibial shaft fractures: should they be nailed? Clin Orthop Relat Res 1995 ; 315 : 64 – 74 . 2

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Andrew Kailin Zhou Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
West Hertfordshire Hospitals NHS Trust, London, United Kingdom

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Eric Jou Kellogg College, University of Oxford, Oxford, United Kingdom

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Victor Lu Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom

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James Zhang Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, United Kingdom

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Shirom Chabra Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom

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Matija Krkovic Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

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this is part of an extensive armoury of treatment methods. A study conducted during the late 1900s investigated whether proximal third tibial shaft fractures should be treated with IM nails with no mention of poller/blocking screws ( 13 ). Lang et al

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Carlos A. Encinas-Ullán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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José M. Martínez-Diez Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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E. Carlos Rodríguez-Merchán Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain

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(93%). Tibia Milenkovic et al analysed 32 patients with segmental tibial shaft fractures (AO/OTA 42–C2), with an average age of 43 years. 26 Average time of union was 5.9 months for closed and 6.2 months for open fractures. Average follow

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Hakan Ömeroğlu TOBB University of Economics and Technology, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey

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Manuel Cassiano Neves CUF Descobertas Hospital, Department of Paediatric Orthopaedics, Lisbon, Portugal

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Cruz AI Jr . Increasing rates of surgical treatment for paediatric tibial shaft fractures: a national database study from between 2000 and 2012 . J Child Orthop 2019 ; 13 : 213 – 219 . 31. Stenroos A Laaksonen T

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Andreas Frodl Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Benjamin Erdle Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Hagen Schmal Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany
University Hospital Odense, Dep. Of Orthopedic Surgery, Sdr. Boulevard 29, 5000 Odense C, Denmark

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Introduction Distal lower-leg fractures often occur with a tibial fracture in conjunction with a fibular fracture. It is common practice not to fix the fibula in patients presenting tibial shaft fractures. In case of a fracture in the lower

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