PROXIMAL 3RD TIBIAL SHAFT FRACTURES - SHOULD THEY BE NAILED

Thirty-two extraarticular fractures of the proximal third of the tibia were treated with locked intramedullary nails. There were 10 closed a nd 22 open injuries. Treatment consisted of a reamed nail in each of t he 5 closed fractures, and an unreamed nail in the remaining 27 fractu res. Thirty of the 32 fractures eventually healed; however, 9 (28%) un derwent exchange nailing and 4 (13%) required bone grafting. At final followup, 27 of 32 fractures (84%) had angulation of 5 degrees or grea ter in the frontal or sagittal plane. Nineteen of the 32 fractures (59 %) had 1 cm or more of displacement at the fracture site. In 8 fractur es (25%), there was loss of fixation, most commonly associated with pl acement of a single proximal locking screw. Fractures of the proximal third of the tibial shaft do not appear to respond as favorably to int ramedullary nailing as do fractures in the distal 2/3 of the tibia. Va lgus, apex anterior angulation, and residual displacement at the fract ure site are common after nailing. Surgical errors of a medialized nai l entry point and a posteriorly and laterally directed nail insertion angle contributed to malalignment. Based on their findings, the author s have limited the use of intramedullary nailing for proximal third ti bial shaft fracture and consider alternate forms of fixation (plate or external fixation).