Segmental tibia fractures: A prospective evaluation

Debate exists regarding the treatment of segmental tibia fractures. We report a large series of segmental fractures treated with a single technique of nonreamed nailing and report the time to union, reoperation rate, and associated complications. Emphasis was placed on achieving an anatomic reduction with good interfragmentary contact. We prospectively followed 62 consecutive patients with closed and open segmental tibia fractures (Orthopaedic Trauma Association Type 42-C2). Three patients died and eight were lost to followup, leaving 51 patients followed to union. Forty-six of the 51 fractures (91%) united with one operation (average time to union 138 days in closed fractures and 178 days in open fractures). Five patients had secondary procedures before achieving union. Type 3B fractures and those associated with compartment syndrome had the longest time to union, averaging 294 days. Full weightbearing was achieved within 3 months for all closed fractures and 74% of open fractures. There were no deep infections or nail or screw breakages in the series and knee pain occurred in 14 patients (27%). Nonreamed nailing is associated with high union rates, few complications, and limited indications for secondary procedures in the management of segmental tibia fractures.