Fractures of the tibia and fibula. A follow-up study of the initial 64 patients treated at the University Hospital, Kuala Lumpur, Malaysia

Low-intensity pulsed ultrasound: effects on nonunions

To study the efficacy of low-intensity pulsed ultrasound (US), or LIPUS, of 85 treated nonunion cases with a minimum fracture age of 8 months, 67 cases met the study criteria. These were: no surgical intervention during 4 months before US treatment and radiographically ceased healing for 3 months before US. In a self-paired control study, the mean fracture age of the 67 patients was 39 +/- 6.2 months. After a daily 20-min US treatment at home for an average of 168 days, 85% (57 of 67) of the nonunion cases were clinically and radiographically healed. The study did not include any cases that were malaligned, grossly instable, actively infected or that had extensive bone loss. The results demonstrate that the specific US can effect heal rates similar to those achieved by surgical means, without the associated risks and complications, and to those achieved by electrical bone growth stimulation or by extracorporeal shock-wave therapy.

The results of operative and non-operative management of tibial fractures

A series of 160 fractures of the tibia in 155 patients is analysed. Eighty patients were operated on' intramedullary nails were used in 33, AO plates in 29 and screws in 18 cases. In the final evaluation the result was classified as good in 39, fair in 27, and poor in 14 cases in the non-operative group, and 40, 25 and 15 in the operative group. Fracture comminution had a significant effect on foot and ankle motion.