Closed nailing of tibial shaft fractures.

A total of 98 tibial shaft fractures were internally fixed by closed intramedullary nailing. Twenty-seven of the fractures were open and 71 were closed. In 62 patients (67 per cent) the fracture was the consequence of road traffic accidents; 32 patients (35 per cent) had other skeletal and soft tissue injuries. All the fractures united with a good range of knee and ankle movements; no disuse atrophy was encountered. Most patients returned to work early. In 14 patients comminution of the fracture resulted in up to 2 cm of shortening. Eight tibial fractures had delayed union. It is concluded that tibial nailing is a safe method of treatment for unstable fractures and for patients with multiple injuries.