Implant failure in tibial nailing

Between 1991 and 1995 five hundred and twenty tibial diaphyseal fractures were treated with intramedullary nailing in Northern Ireland. We retrospectively reviewed three hundred and thirty eight patients in three out of the four fracture units in Northern Ireland. Within this group there were three hundred and forty fractures and we identified twenty five episodes of implant failure. This group of patients had a higher percentage of open injuries with a higher degree of comminution and had been treated with smaller diameter nails when compared with the group of patients, who had no implant failure. Failure occurred most frequently at the transverse proximal locking screw when a single screw was used. Fractures in the distal third of the tibia had a higher incidence of nail breakage. We would recommend early elective dynamisation and the use of statically locked larger diameter nails, especially in comminuted or distal third fractures.