Segmental Tibia Fractures

Fractures of the tibia account for approximately 17-21% of all lower extremity fractures and approximately 2% of all combined fractures [1,2]. Within this number, 3% to 13% of tibia fractures are classified as segmental with most literature on this injury consisting of case series or retrospective reviews [3,4]. Segmental fractures of the tibia present a challenge to treating orthopedic surgeons due to their infrequent presentation, wide zone of tissue injury, and increased rate of complications. Segmental tibia fractures (AO 42-C2) are defined by two or more distinct fracture lines isolating an interposed cortical segment which excludes butterfly fragmentation [5]. Severe soft tissue defects are common due to their association with high energy trauma mechanisms of injury [6]. As a result of the trauma to the surrounding soft tissues approximately 15% of tibial shaft fractures represent open injuries with reports of segmental tibia fractures having an open injury 53% to 80% of presentations [79]. The perfusion of the intermediate segment is provided through endosteal and periosteal blood supply, which sustains increased damage leading to impaired fracture healing with the already precarious blood supply of the intermediary cortical segment [6,10]. With this in mind Woll et al. classified segmental tibial fractures as “an extremely high risk injury” with postoperative complications noted more frequently than in any other category of tibia fracture [6,8]. Classification