Implant failure in tibial nailing

Between 1991 and 1995 five hundred and twenty tibial diaphyseal fractures w ere treated with intramedullary nailing in Northern Ireland. We retrospecti vely reviewed three hundred and thirty eight patients in three out of the f our fracture units in Northern Ireland. Within this group there were three hundred and forty fractures and Eve identified twenty five episodes of impl ant failure. This group of patients had a higher percentage of open injurie s with a higher degree of comminution and had been treated with smaller dia meter nails when compared with the group of patients, who had no implant fa ilure. Failure occurred most frequently at the transverse proximal locking screw when a single screw was used. Fractures in the distal third of the ti bia had a higher incidence of nail breakage. We would recommend early elect ive dynamisation and the use of statically locked larger diameter nails, es pecially in comminuted or distal third fractures. (C) 2000 Elsevier Science Ltd. All rights reserved.