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The authors have studied a series of 521 fractures of the tibia treated by blind intramedullary nailing without reaming. Union by the 120th day was obtained in 93.3% of cases. Malunion was uncommon and was related to an inadequate initial reduction. A secondary procedure was only necessary in two cases of malunion. In closed fractures, no case suffered infection. In compound fractures, 4.3% became infected (5 osteitis, 4 septic non-union) but all cases were cured by secondary procedures. Aseptic non-union occurred in 2.3% of cases. The authors recommend the use of nails of at least 8 mm diameter driven down to the region of the lower articular surface. In patients with a narrow medullary canal, or in fractures of the lower third of the tibia, the authors consider that reaming would have given better results. In other types of fracture reaming is more hazardous than useful.

The prosthesis has two components. The femoral component is metallic surfacing the condyle and a tibial plateau in polyethylene replaces the original one. The prosthesis can be uni or bi-condylar. Operative technique has to be very precise and the position of the prosthesis needs accuracy. The advantages are: minimal bone resection, small implant harmonic action with the knee joint as a whole. 20 patients with I8 months follow up are reviewed, problems are infections and pain in the patello-femoral joint. The results on pain and walking are good. Stability depends on accurate indications.