Abstract
1. A study of the late results of 343 soundly united tibial shaft fractures was carried out. Limitation of ankle and/or foot movement occurred in twenty-one patients (6 per cent) and was found to be the most important cause of disability. Knee stiffness (2·3 per cent of cases) and shortening of up to three-quarters of an inch (5·5 per cent of cases) caused little functional impairment.
2. Stiffness of the foot and ankle was correlated with the severity of injury, occurring in 1 per cent of minor, 5 per cent of moderate and 22 per cent of major injuries.
3. One-third of the patients with limitation of foot and ankle movement had clinical evidence of ischaemic contracture.
4. It is argued that, in the absence of direct injury to the joint, persistent joint stiffness is caused by replacement fibrosis of soft tissues. This may result either from direct tissue injury or from associated vascular damage.
