The statistical analysis of Segment 42- was carried out based on the classification of 1990. The current classification was published in French in 1996.

The diaphyseal fractures of the tibia (10,84% of the total) have historically been the center of the discussion about conservative versus surgical treatment and, regarding internal fixation, there still is discussion between the advocates of the intramedullary nailing procedures and the plate proponents. As for the femoral diaphysis, some schools advocate alignment multiple nailings and, recently, the unreamed interlocked nails. Simultaneously, multiple models of external fixators have become available for the treatment of open fractures, to be used either as a provisional or as a definitive treatment, either alone or associated with plates or isolated screws.

The tibial diaphysis is the testing ground for the majority of the surgeons; However, it was never so for us because it was precisely with the tibia that we learned how to apply the procedures of the AO technique. Several hundreds of operated cases have given satisfactory results and the complications have always been because of our own mistakes in the application of the technique. The tibial diaphysis is a quite accesible bone on which meticulous approaches can be carried out, allowing a very precise performance of the previously planned compressed internal fixation.

The reamed intramedullary nailings are the main indication for some of the fractures that involve the middle third of the diaphysis, but we maintain our reticence about the helpfulness of the interlocking systems (too many times indiscriminately used) compared with the plates. We do not consider the multiple intramedullary nailings, with wires of whatever thickness, an alternative technique of treatment. Instead, we value positively the combination of an external fixator with an internal fixation “ad minimum” for some open fractures.

For indication purposes, we clearly separate the fractures that involve the middle third from those that involve the proximal or the distal third of the tibial diaphysis, a factor of the same or even greater significance than the nature of the fracture line. The simultaneous involvement of the fibula and its level in relation to the tibial fracture are other fundamental aspects that must be taken into account for the preoperative planning, because they are very important components of added severity.