INTRAMEDULLARY NAILING OF THE TIBIA WITHOUT A FRACTURE TABLE - THE TRANSFIXION PIN DISTRACTOR TECHNIQUE

A series of 44 fractures of the tibia requiring operative stabilizatio n were treated using an intraoperative external transfixion pin frame to correct angular deformity and maintain length in preparation for in tramedullary (IM) nailing, eliminating the need for a fracture table. The technique requires a radiolucent operating room table; the injured extremity is draped free. A transfixion pin is inserted in the os cal cis. Rotational deformity is manually corrected. Using fluoroscopic co ntrol, a second transfixion pin is inserted at a location just distal and parallel to the proximal tibial articular surface, paralleling the horizontal plane of the first pin. The transfixion pins are connected with carbon fiber rods, creating a rectangular frame. Manual fracture reduction is followed by ''fine tuning'' with compressor/distractor c lamps as needed. Alternatively, for added reduction force, the carbon fiber rod on the concave side of the angular deformity may be replaced with the AO/ASIF universal distractor. IM nailing is then performed i n the usual fashion. In this series, an acceptable reduction was obtai ned in all cases. This technique shortens setup time, provides complet e access to the distal part of the tibia, and allows free manipulation of the limb, thereby facilitating nail insertion and placement of dis tal locking screws. Use of medial and lateral bars prevents the angula r deformity often created or exacerbated with the use of the universal distractor alone. This technique is recommended for IM nailing of all fractures of the tibia that would otherwise require use of the fractu re table or universal distractor.