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Flexible intramedullary nailing of tibial-shaft fractures.

Closed flexible intramedullary nailing was used in 38 fractures of the tibia shaft. Simple transverse, oblique, or spiral fractures were shown to be stable after nailing. Fractures with a large unicortical butterfly fragment, involving more than one-third of the cortex, had a tendency to angulate. There were 23 fractures in the distal third of the tibial shaft; nine in the middle third; and four in the proximal third. The operations were simple and quick, lasting an average of 38 minutes. Sixteen patients used a short walking cast, usually for periods of four to six weeks. The cast was usually applied for comfort. The average healing time was 14.3 weeks. There were three cases of delayed and nonunion. In one patient, significant increase in valgus deformity occurred and required a renailing procedure. There was one case of osteomyelitis in a patient who had a Grade 3 open tibial fracture, which was debrided with a considerable delay.