Percutaneous toggle technique for manipulating displaced, unstable, and nonreducible proximal tibial fractures in children.

Reducing displaced and unstable tibial fractures of the proximal metaphysis can be challenging. Closed reduction with subsequent casting may fail to achieve acceptable anatomic alignment, potentially resulting in deformity or increasing the risk for compartment syndrome. A method is presented for aligning the opposing fragments by inserting a guide pin percutaneously to manipulate the proximal and distal segments in preparation for percutaneous Kirschner-wire stabilization. Using this percutaneous toggle technique lessens the chance that open reduction will be needed and thus avoids the inherent risks associated with open procedures.