[Retrograde nailing in a tibial fracture]

Area of Science:

• Orthopedic surgery
• Trauma management
• Bone reconstruction

Background:

• Severe comminuted open tibial fractures present complex challenges.
• Significant bone stock loss and joint involvement necessitate advanced treatment strategies.

Observation:

• A case involving a type IIIA open tibial fracture with 7 cm distal bone loss, complete tibial joint surface involvement, and fibular-talar joint instability.
• Initial treatment included wound debridement, retrograde tibial nailing with proximal/distal blocking, and fibular-talar Kirschner nailing.

Findings:

• Primary skin closure was achieved.
• A secondary autologous iliac crest bone graft addressed the bone defect.
• The tibial nail was reimpacted and dynamized distally.
• Bone defect consolidation occurred within 16 weeks.
• Successful tibial-astragalar arthrodesis and pain-free ambulation were achieved.

Implications:

• This surgical technique demonstrates a viable solution for complex tibial fractures with extensive bone loss.
• The combined use of retrograde nailing and bone grafting can restore joint function and mobility.
• Highlights the potential for successful outcomes in challenging orthopedic trauma cases.