THE USE OF THE UNREAMED NAIL IN TIBIAL FRACTURES WITH CONCOMITANT PREOPERATIVE OR INTRAOPERATIVE ELEVATED COMPARTMENT PRESSURE OR COMPARTMENT SYNDROME

Twelve patients with tibial shaft fractures and evidence of compartmen t syndrome or with documented elevated compartment pressures were trea ted with an unreamed locked intramedullary nail and a single-incision lateral four-compartment fasciotomy. There were six closed fractures a nd three grade I and three grade II open fractures. Ten fractures have achieved a solid union without shortening or significant angulation a t an average follow-up of 8.1 months (range 4-26). Two patients were l ost to follow-up. There were two delayed unions and one nonunion, all of which healed after additional treatment. Average time to tibial uni on was 5.8 months (range 2-24), with six fractures healing in less-tha n-or-equal-to 4 months. One patient whose treatment was delayed > 12 h after his injury has a persistent neurologic deficit with a claw toe deformity. There were no superficial or deep infections. All patients obtained an excellent range of motion of the knee and ankle. Unreamed nailing of diaphyseal tibial fractures with an associated compartment syndrome provides optimal internal fixation while allowing excellent a ccess for soft tissue care. We believe that the unreamed tibial nail, when combined with a single-incision, lateral, four-compartment fascio tomy, offers substantial advantage in the treatment of this injury, pe rmitting optimal treatment of a difficult fracture and soft tissue inj ury.