OBJECTIVETo explore the clinical effects of delayed open reduction and locking compressing plate (LCP) plus bone-grafting in medullary cavity for the distal comminuted fractures of tibia.

METHODSTwenty-nine patients with the distal comminuted fractures of tibia were treated between March 2006 and September 2008, including 19 males and 10 females, ranging in age from 27 to 58 years with an average of 42.5 years. From wounded to hospital, the time was from 2 to 4 hours. According to AO classification, type 43-A1 were in 3 cases, type A5 in 12 cases, type A3 in 9 cases and type 43-C1 in 5 cases. Among them, there were 11 cases with open fracture (type Gustilo I in 5 cases, type Gustilo II in 6 cases) and 18 cases with closed fracture. Calcaneal traction was done in earlier stage (plaster external fixation in 5 cases), keeping the nagative liquid balance and electrolyte balance and improving the microcirculation. After the swolen limbs relieved markedly in 8 to 12 days,operating was done by open reduction and LCP internal fixation plus bone-grafting with own ilium in medullary cavity. Functional exercise was undergone in earlier stage and the wounded limbs loading weight on 10 to12 weeks after operation when the X-ray revealed the callus formed markedly.

RESULTSThe incision healed well without severe complication. All patients were followed up for from 6 to 14 months with an average of 12 months. All cases obtained bone union. According to the Mazur's evaluation standard, the results were excellent in 25 cases, good in 3 cases, and fair in 1 case.

CONCLUSIONThe above treatment can reduce the damage of periosteum and medullary cavity, shorten the time of bone healing and decrease the rate of bone nounion markedly. The internal fixation was reliable and less complacation after surgery, but it is very important for the right preoperation assessment to soft tissue injuries and the good operation timing choice.