الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Tibial fractures are the most common long bone fracture and occur at a frequency of about 26 fractures per 100,000 population per year(25).They are approximately three times more frequent in males than in females and the average age of patients is about 37 years(26) , In males, tibial fractures are common in the adolescent age group and are generally attributed to higher energy trauma such as motor vehicle accidents(25). The frequency of their occurrence increases again later in life with the development of osteopenia and osteoporosis. Treatment options are conservative in above knee cast, or operative by plates and screws, inter locking nails which consider best management of closed tibial shaft fracture The average time of healing fracture tibia within 20 weeks. This is highly variable, depending on fracture pattern and soft tissue injury. Delayed union is defined as >20 weeks. Nonunion this occurs when clinical and radiographic signs demonstrate that the potential for union is lost, including sclerotic ends at the fracture site and a persistent gap unchanged for several weeks. Nonunion has also been defined as lack of healing 9 months after fracture. Smoking has deleterious effects on blood vessels and the efficient transport of oxygen to the cells of the body, and various processes that allow wounds to heal(6). Nicotine causes vessels to narrow inhibits the function of red blood cells, and other chemicals present in cigarette smoke decrease the level of oxygen present in blood. This has a negative effect on those cells that are trying to divide and grow after injury or surgery. These cells cannot divide as quickly or synthesize enough of the products they need to make repair of the surrounding tissue as a result this lack of oxygen, leading to longer healing times and increased risk of improper healing(7).