It generally is accepted that fractures of the tibia located in the proximal and distal thirds tend to angulate more than
midshaft fractures when treated with intramedullary nails. We therefore compared the angular deformities and final shortening
of 434 closed fractures located in the middle third of the tibia treated with a functional brace with those in fractures in
the proximal and distal thirds treated in the same manner. Ninety-seven percent in the middle third healed with 8° or less
angulation in the mediolateral plane, which was a higher percentage than we had experienced in distal and proximal third fractures
treated with this method. Nonunions occurred in four (0.9%) fractures. We found correlations between initial shortening, final
shortening, initial displacement, final displacement, and time to brace with initial angulation and final angulation in the
mediolateral and anteroposterior planes. The overall mean final shortening of the fractures located in the middle third was
4.3 mm. These experiences suggest satisfactory results can be obtained in most instances using a functional brace for management
of closed fractures of the middle third of the tibia.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.