The Use of an External Fixator to Heal a Pathological Tibial Shaft Fracture

Tibial shaft fractures are typically the result of high-energy injuries, however bone that has been substantially weakened may be susceptible to fractures without a preceding traumatic incident. Such bone weakening may occur secondary to malignant disease but also in chronic conditions such as Paget's disease. The altered structural properties of Pagetic bone and cellular changes including increased vascularity complicate the orthopaedic management of fractures in these patients. In is common practice to repair tibial fractures using intramedullary nails which provide full-length fixation of the bone and thus stability and alignment during bone healing. Here we describe an alternative method for the surgical management of a fracture of the tibial shaft in a patient with Paget's disease. We successfully achieved clinical and radiological healing of the tibia in all cortices.