The case for an open approach to tibial nailing.

Medullary nailing of the tibia without exposing the fracture site is a technically possible procedure. In order to test if it is a superior method to open nailing, a retrospective study of 55 cases was undertaken; 35 had been nailed by the closed technique and 20 by open operation. All fractures united. Knee movements were full unless there had also been other injuries. Complications were common; infection occurred in 20 per cent of open nailings and in 31 per cent of closed nailings . Twenty per cent of the tibias showed rotational deformities and 9 per cent of patients developed peroneal nerve palsy. Complications occurred less frequently in cases operated on by an open technique. It is suggested that opening the fracture site may reduce the complication rate.