Flexible intramedullary nailing of tibial shaft fractures

At the author's institution, flexible intramedullary nailing of long bones is most commonly used in tibial fractures. The 4.0-mm nails are most frequently used and are supplemented with the 3.5-mm nails. Over 95% of the nailed tibial fractures are stabilized in the antegrade method directed from the proximal tibia into the distal fragment. Retrograde nailing is done most often to supplement the stability of fractures in the distal third. Surgery can be performed on a standard fracture table with the patient placed on a radiotranslucent board; a biplanar image intensifier is required. Functional bracing is used four to six weeks after surgery. Early solid union is obtained even in comminuted fractures.