Expandable nailing system for tibial shaft fractures

Summary Objective To evaluate and present our current clinical experience in the treatment of closed and open tibial shaft fractures using the expandable intramedullary nailing system. Design Prospective study. Setting One level-1 trauma centre. Participants Twenty-six patients with acute tibial shaft fractures with at least 10 cm of intact cortex on both sides of the fracture. Intervention Internal fixation using the Fixion expandable intramedullary nail (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel). Main outcome measurements Operative and fluoroscopy time, healing time and perioperative complications were recorded. Results Twenty-six tibial fractures were treated (OTA classification: 3 type A1, 8 A2, 8 A3, 3 B1, 3 B2, and 1 B3), six of which were open. All fractures healed by week 18.5 with an mean of 12.8 ± 3.8 weeks. The operating time ranged from 20 to 50 min with an mean of 40 ± 12.17 min. The fluoroscopy time ranged from 6 to 22 s with a mean of 10 ± 5 s. In one case the nail failed to expand, as detected by X-ray control, and had to be exchanged intraoperatively. Two patients reported anterior knee pain during the follow up, but did not wish any further treatment. In a low demanding patient rotational malalignment was noted and no further action needed. Conclusion According to the results of this study, the use of the Fixion nailing system, where indicated, is associated with minimal complications and very good functional outcomes in fractures OTA types A and B. The advantages of the expandable nail include the decrease in the operating and fluoroscopy time and the simplicity of its application.