Complicated open fractures of the distal tibia treated by secondary interlocking nailing

From January 1987 through December 1990, 28 consecutive distal tibial complicated open fractures in adults treated with primary external fixation and secondary closed Grosse-Kempf interlocking nails were prospectively studied and followed up for at least 1 year. All fractures were type IIIb open fractures and local soft-tissue coverage was performed at 3 to 5 days. The external fixation was maintained for an average of 22 days. The closed interlocking nails were inserted about 2 weeks after Hoffmann pins were removed. The results revealed a union rate of 85.7% (24 of 28) with a period to union of 5.8 +/- 1.4 months. Complications included 14.3% nonunion rate and a 7.2% deep infection rate, which were not difficult to treat. We conclude that secondary closed interlocking nailing is a simple and effective technique in treating distal tibial complicated open fractures.