We treated 112 fractures of the tibia by manipulative reduction, reaming
of the medullary canal, and fixation of the fracture fragments with an
intramedullary nail. Seventy-six of the fractures were acute, and eight of
these were second or third-degree open fractures. The other thirty-six
fractures had a non-union, osteotomy for malunion, or failure of other
types of treatment. Follow-up of 100 fractures showed union in all but one,
which was in a drug abuser who had an amputation due to infection. The main
complication was infection, which was successfully treated in six of seven
fractures. The method of treatment, employing either closed or open
technique and recently making use of interlocking bolts to stabilize one or
both principal fracture fragments on the nail, is an excellent one for
unstable acute fractures and for secondary procedures in fractures that are
not associated with infection. The infection rate was increased with the
open surgical technique. The few contraindications to its use are
described.