NONREAMED INTERLOCKED INTRAMEDULLARY TIBIAL NAILING - ONE COMMUNITYS EXPERIENCE

Forty-nine acute displaced tibial fractures (31 closed, 18 open: 5 Gra de I, 7 Grade II, 4 Grade IIIA, and 2 Grade IIIB) were treated in 1 co mmunity with a standard operative protocol using a distracter without a fracture table, and an unreamed interlocked tibial nail. Forty-six f ractures healed (94%). Complications included 3 nonunions (6%), 2 deep infections (4%), 9 delayed unions (18%), 4 angular malunions (8%), 2 rotatory malunions (4%), and 12 interlocking screws bent or broke (24% ). Twenty-eight patients (57%) required at least 1 additional operatio n to obtain union, most commonly dynamization of a statically locked n ail. The authors conclude that unreamed tibial nails provide adequate stabilization of displaced tibial fractures and can be used in the man agement of most open or closed tibial fractures. However, static locki ng is required in axially unstable fractures. Early dynamization or ex change nailing and bone grafting should be considered to hasten union and avoid screw failure. The distracter is an excellent adjunctive tec hnique for reduction and alignment of tibial shaft fractures during in tramedullary nailing.