The treatment of open tibial fractures using nonreamed flexible intramedullary fixation

Many fixation methods for the treatment of open tibial fractures have been devised, studied, and compared, but controversy persists regarding the most suitable means of immobilization. Nonreamed flexible intramedullary fixation nails, such as Ender rods, have proved an excellent alternative for stabilizing a variety of open tibial fractures with varying degrees of soft-tissue damage. These nails act as an internal splint, which provides three-point fixation; preserves much of the primary blood supply of the tibia; allows for maintenance of length, alignment, and rotation; and facilitates healing of adjacent injured soft tissues. Their use deserves consideration in treating most open diaphyseal tibial fractures.