Tibial fractures treated with pins and plaster.

The use of transfixing pins incorporated into a plaster cast has been considered a relatively risk-free treatment for tibial fractures. Reviews of this treatment report high union and low complication rates. This paper reports a retrospective review of 42 tibial fractures treated with pins and plaster, with a minimum follow-up of two years. We found a significant rate of nonunion, delayed union, malunion, and secondary surgical procedures. Local complications attributable to the use of pins were also present in this study. Based on our findings, we recommend the following: (1) accurate anatomic reduction (minimal displacement is acceptable but no distraction), (2) early weight bearing, (3) pin removal at six to eight weeks, and (4) limitation of pin-and-plaster treatment to low-energy fractures when the reduction cannot be held by casting.