Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation.
BACKGROUND
Fractures of the proximal and distal one thirds of the tibial shaft have historically higher malunion rates than those of the midshaft. This retrospective case series evaluates the postoperative radiographic outcome of intramedullary nailing of proximal and distal one-third tibial shaft fractures using intraoperative two-pin external fixation, often referred to as traveling traction.


METHODS
Between 2000 and 2005, 15 consecutive patients with proximal third and 27 consecutive patients with distal third displaced extra-articular fractures of the tibia were treated with statically locked intramedullary nailing and supplementary intraoperative two-pin rectangular frame external fixation. The external fixation was removed once the proximal and distal locking screws were in place. The alignment of the fractures was determined using standard postoperative anteroposterior and lateral radiographs.


RESULTS
Postoperatively, 14 of 15 patients with proximal fractures and 25 of 27 patients with distal fractures had less than 5 degrees of angular deformity in both the coronal and sagittal planes and less than 1 cm shortening.


CONCLUSIONS
Statically locked intramedullary nailing with simultaneous intraoperative traveling traction external fixation as treatment for proximal and distal one-third extra-articular tibial shaft fractures is successful in achieving a high rate of acceptable postoperative alignment.
Department of Orthopaedic Surgery, John H. Stroger Hospital of Cook County and Rush University Medical Center, Chicago, Illinois 60612, USA. robertwysocki@mac.com
Robert W
RW
Wysocki
James S
JS
Kapotas
Walter W
WW
Virkus
D001858:Bone Nails; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017759:Fractures, Malunited / Q000517:prevention & control; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*