Eighteen patients with tibial fractures treated by plating that had
failed were treated by intramedullary nailing. Nine patients had a broken
plate or screw that had pulled out. In seven, the plate and screws were
intact but no healing was evident, and in two patients the plate was intact
but one or more screws were broken. The plate and screws were removed from
all patients and immediate limited open intramedullary nailing was done
with a Kuntscher nail after the bone was reamed. In one patient the method
failed, while in fifteen patients the fracture united and in the two
remaining patients who could not be contacted union was thought to be in
process when they were last seen, five and ten months postoperatively. Two
bone grafts were used in one patient. Six fibular osteotomies were
performed in conjunction with the intramedullary nailing.