BREAKAGE OF AN UNREAMED TIBIAL NAIL (UTN)

A solid AO unreamed tibial nail was found to be broken at the revision operation for a pseudoarthrosis following open tibial fracture treatm ent in a 17-year-old girl, The nail breakage had not been detectable i n the roentgenograms, Access to the broken nail was achieved through a longitudinal osteotomy via the tibial tuberosity. A metal drill was u sed to drill a 5-mm hole proximally into the medial aspect of the nail . There the tip of an elevatorium could be inserted, which allowed for ce to be applied along the longitudinal axis of the nail. Additionally , another longitudinal osteotomy had to be performed immediately dista l to the pseudoarthrosis, and a bone distracter was applied in between . Thus, the nail loosened and could be removed completely. The bony de fect was filled with autologous bone graft and a 9-hole AO tibial plat e was applied to stabilize the tibia. We report on the breakage of thi s system and the surgical management of this complication.