Tibia, Diaphysis

Abstract

Fractures of the tibia are brought on by a variety of high-energy injury mechanisms and are prone to complications. The lack of a circumferential soft tissue envelope around the bone makes the bone ends more likely to fail to unite. The soft-tissue envelope is the most important component in the evaluation and subsequent care of tibia fractures. Surgeons have moved away from plates and external fixators in favor of intramedullary nails in the operative treatment of both closed and open tibia diaphyseal fractures. Nailing is done with the patient in the supine position on a radiolucent table or on a fracture table with the knee flexed at least 90°. Experimental data suggest that reamed nails offer greater biomechanical stability and increased soft tissue blood flow, while non-reamed nails preserve blood flow to the bone. Locking with bolts or interlocking screws is mandatory for small-diameter nails in order to improve stability in a wide medullary canal and is recommended in all other situations. Poller screws aid in obtaining satisfactory alignment during surgery and provide additional stability. When strategically placed, these screws guide the reamers and the nail to a suitable trajectory, thereby achieving indirect reduction. Fibula fixation will provide good landmarks for the length of the tibia and add stability. The most common complication of intramedullary nailing of tibia fractures is anterior knee pain, which has been reported in more than half of patients. Malalignment, malunion and nonunion can be avoided by a meticulous surgical technique.