A 30-year-old man sustains a closed, minimally displaced transverse fracture of the middle third of the tibial shaft with less than 5 degrees of angulation and no shortening. Soft tissues are intact. The most appropriate definitive management is:
- A Plate fixation through a posteromedial approach
- B Closed reduction and a patellar tendon bearing functional cast brace allowing early weight bearing ✓
- C External fixation followed by bone grafting
- D Below-knee plaster immobilisation with non-weight bearing for 12 weeks
Correct answer: B. Closed reduction and a patellar tendon bearing functional cast brace allowing early weight bearing
Explanation
Sarmiento showed that closed low-energy tibial shaft fractures with acceptable alignment heal reliably in a patellar tendon bearing functional cast brace with early weight bearing, achieving union rates above 95 percent with shorter time to consolidation than rigid fixation. Plate fixation invites infection and hardware prominence, and prolonged non-weight bearing causes stiffness and disuse osteoporosis without improving union.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.