The treatment of unstable fractures of the tibia and fibula with flexible medullary wires. A review of two hundred and thirty-five fractures.

A retrospective study was done of the treatment of closed and open unstable fractures of the tibia and fibula with flexible intramedullary wires in 223 patients with 235 fractures. The surgical procedure is relatively atraumatic to the tibia, can be learned easily by the surgeon, and does not require complicated or expensive instrumentation. The flexible intramedullary wires permit stabilization of the fractures in a functional position. External support by a long cast in the initial phase of treatment is necessary, but full weight-bearing is usually allowed during the third to fourth week. This has proved to be a beneficial method of treatment for bilateral fracture of the tibia and fibula and for combined femoral and ipsilateral tibiofibular fractures. Of the 235 fractures, fifty-seven (24.3 per cent) were closed and 178 (75.7 per cent) were open. Primary healing of soft tissue and bone occurred in fifty-three (92.9 per cent) of the closed fractures and in 117 (65.7 per cent) of the open fractures. The complication rate in closed fractures was 7.1 per cent, primarily due to delayed bone union. There was a 34.3 per cent complication rate in the open fractures, of which thirty-one (17.4 per cent) showed delayed soft-tissue healing, ten (5.6 per cent) had delayed bone union, and eight (4.4 per cent) resulted in deep infection with osteomyelitis. There were eight non-unions in the open, uninfected fractures, five of which healed after bone-grafting. Flexible intramedullary wiring of the tibia should be considered as an alternate method of treatment in the presence of an unstable fracture.