title: A multicentre case series of tibia fractures treated with the Expert Tibia Nail (ETN).
abstract: BACKGROUND
  The aim of this study was to present clinical experience and outcomes of intramedullary nailing of proximal, midshaft and distal tibia fractures with the Expert Tibia Nail (ETN; Synthes GmbH, Switzerland), an implant offering a wide range of proximal and distal locking options in multiple planes to increase stability of the implant and bone construct.
  
  
  METHODS
  180 patients with 185 tibia fractures were enclosed between July 2004 and May 2005 from ten trauma units (Levels I, II and III) and treated with intramedullary reamed and unreamed nailing with the ETN. Patients attended examinations at 12 weeks and 1 year. The occurrence of postoperative complications was documented as well as the outcomes of fracture healing, primary and secondary malalignment, implant failure, rate of infection and the need for reoperation.
  
  
  RESULTS
  The 1-year follow-up rate was 81 %. At 1 year, the prevalence of delayed union was 12.2 % and higher for open fractures (18.2 %) compared to closed fractures (9.7 %). According to the fracture location, the percentage of delayed union was 5.9, 16.7 and 10.5 % in proximal third, midshaft and distal third cases, respectively. Patients with a plated fibula fracture had an eightfold higher risk of delayed union. The rate of malalignment >5° in any plane 1 year after surgery was 5.5 %. Proximal third fractures were at a higher risk of postoperative malalignment (17.6 %). The rate of secondary malalignment was 1.4 %. The risk of unplanned reoperation was 9.2 %.
  
  
  CONCLUSIONS
  Intramedullary ETN fixation of tibia fractures results in low rates of delayed union, primary and secondary malalignment, implant-related complications, and secondary surgery. Fibula plating had a negative effect on the healing of the tibia.
authors.affiliation: Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, Austria. rene.attal@uki.at
authors.forename: Rene
authors.initials: R
authors.lastname: Attal
authors.forename: M
authors.initials: M
authors.lastname: Hansen
authors.forename: M
authors.initials: M
authors.lastname: Kirjavainen
authors.forename: H
authors.initials: H
authors.lastname: Bail
authors.forename: T O
authors.initials: TO
authors.lastname: Hammer
authors.forename: R
authors.initials: R
authors.lastname: Rosenberger
authors.forename: D
authors.initials: D
authors.lastname: Höntzsch
authors.forename: P M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000453:epidemiology / Q000209:etiology; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005599:Fractures, Ununited / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D016268:Internal Fixators; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult