Medullary nailing for fracture of the shaft of the tibia.

The risks of operating on fractures-sepsis and delayed union-are nowhere greater than in the tibia because this bone is covered only by a thin layer of skin and subcutaneous tissue in a region of poor vascular reserve. Medullary nailing allows internal splinting without exposure of the fracture; it confers the benefits of accurate reconstruction, absolute immobilisation and unrestricted movement with less risk than with other methods of internal fixation. It has not gained favour because there has been general satisfaction with closed methods and because the introduction of a nail strong enough to make external splints unnecessary has not been thought possible. The work here reported is based on the idea that it is possible to insert a straight nail of large calibre and cloverleaf section into the fractured tibia. The technique was evolved after experiment in the necropsy room and trial in the operation theatre. It differs from that of Kiintscher only in details.