This cohort study from the SPRINT trial evaluates 37 patients with tibial shaft fractures meeting the Court-Brown definition of a 'critical-sized defect' (gap ≥1 cm, >50% cortical diameter) to determine how often these defects actually require secondary surgery and which patient or fracture factors predict the need for reoperation.
When you encounter a tibial shaft fracture with a bone gap meeting the 'critical-sized' threshold, don't reflexively plan early secondary intervention — nearly half will unite with patience alone, and reamed nailing optimizes that chance.
Counsel patients that even when union is achieved, functional recovery at one year is meaningfully worse than after standard tibial fractures, so set realistic rehabilitation expectations from the outset.
This cohort study from the SPRINT trial evaluates 37 patients with tibial shaft fractures meeting the Court-Brown definition of a 'critical-sized defect' (gap ≥1 cm, >50% cortical diameter) to determine how often these defects actually require secondary surgery and which patient or fracture factors predict the need for reoperation.
When you encounter a tibial shaft fracture with a bone gap meeting the 'critical-sized' threshold, don't reflexively plan early secondary intervention — nearly half will unite with patience alone, and reamed nailing optimizes that chance.
Counsel patients that even when union is achieved, functional recovery at one year is meaningfully worse than after standard tibial fractures, so set realistic rehabilitation expectations from the outset.