![]() ![]() The associated fracture of the fibula was left alone. We considered that it was important to leave sufficient nail for subsequent removal. The fracture was reduced and the nails advanced into the opposite metaphysis. The first nail was advanced to the fracture site and the second introduced from the opposite cortex. The nails were then introduced under fluoroscopic control. The tips of the nails were bent to 45° in order to facilitate passage along the opposite cortex and to aid in fracture reduction. Two nails of equal diameter were pre-bent so that the apex of the bend would lie at the fracture site on opposite cortices. ![]() Under fluoroscopic control, the cortex was broached with a drill of larger diameter than the nail to be inserted. A 2 cm to 3 cm incision was made on either side of the tibia, proximal to the marked entry point. The fracture site and entry point at the level of the metaphysis were marked, taking care to avoid the physis. The appropriate size of nail was determined using the image intensifier. ![]() The affected limb was cleaned and draped. Severity of fractures in our patients, classified using the AO system 4 AO classificationĪll patients were operated upon under general anaesthesia. Our indications for the procedure were polytrauma, open fracture, or failure to achieve a satisfactory closed reduction. During this period, 54 children (43 boys and 11 girls) with 56 unstable tibial diaphyseal fractures (27 right, 25 left, two bilateral) ( Figs 1a and 1b) were treated by this method ( Figs 1c and 1d). We undertook a retrospective review of the notes, theatre records and radiographs of all patients with unstable tibial diaphyseal fractures treated by flexible titanium intramedullary nails (C-Nail, Evollutis, Briennan, France) at our institution between March 1997 and May 2005. We report our experience and results using flexible titanium nails in the treatment of unstable fractures of the tibia in children. Although this technique was initially intended for fractures of the femur, its use has been extended to other long-bone fractures. Stability was achieved by inserting two pretensioned nails from opposite cortices, thereby establishing a three-point fixation. In the early 1980s, Ligier, Metaizeau and Prevot 3 reported the use of flexible intramedullary nails to allow early stabilisation of fractures in children with polytrauma, to facilitate wound care in open fractures and to avoid prolonged immobilisation. 1, 2 Surgical stabilisation has historically been reserved for fractures associated with polytrauma, neurovascular injury, open injury and following fasciotomy for compartment syndrome. The standard treatment for fractures of the tibia in children is manipulation and casting. ![]()
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