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.