Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique

A series of 44 fractures of the tibia requiring operative stabilization were treated using an intraoperative external transfixion pin frame to correct angular deformity and maintain length in preparation for intramedullary (IM) nailing, eliminating the need for a fracture table. The technique requires a radiolucent operating room table; the injured extremity is draped free. A transfixion pin is inserted in the os calcis. Rotational deformity is manually corrected. Using fluoroscopic control, a second transfixion pin is inserted at a location just distal and parallel to the proximal tibial articular surface, paralleling the horizontal plane of the first pin. The transfixion pins are connected with carbon fiber rods, creating a rectangular frame. Manual fracture reduction is followed by "fine tuning" with compressor/distractor clamps as needed. Alternatively, for added reduction force, the carbon fiber rod on the concave side of the angular deformity may be replaced with the AO/ASIF universal distractor. IM nailing is then performed in the usual fashion. In this series, an acceptable reduction was obtained in all cases. This technique shortens setup time, provides complete access to the distal part of the tibia, and allows free manipulation of the limb, thereby facilitating nail insertion and placement of distal locking screws. Use of medial and lateral bars prevents the angular deformity often created or exacerbated with the use of the universal distractor alone. This technique is recommended for IM nailing of all fractures of the tibia that would otherwise require use of the fracture table or universal distractor.