Expandable nailing system for tibial shaft fractures.

Objective: To evaluate and present our current clinical experience in the treatment of closed and open tibial shaft fractures using the expandable intramedullary nailing system.
Design: Prospective study.
Setting: One level-1 trauma centre.
Participants: Twenty-six patients with acute tibial shaft fractures with at least 10 cm of intact cortex on both sides of the fracture.
Intervention: Internal fixation using the Fixion expandable intramedullary nail (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel).
Main Outcome Measurements: Operative and fluoroscopy time, healing time and perioperative complications were recorded.
Results: Twenty-six tibial fractures were treated (OTA classification: 3 type A1, 8 A2, 8 A3, 3 B1, 3 B2, and 1 B3), six of which were open. All fractures healed by week 18.5 with an mean of 12.8+/-3.8 weeks. The operating time ranged from 20 to 50 min with an mean of 40+/-12.17 min. The fluoroscopy time ranged from 6 to 22s with a mean of 10+/-5s. In one case the nail failed to expand, as detected by X-ray control, and had to be exchanged intraoperatively. Two patients reported anterior knee pain during the follow up, but did not wish any further treatment. In a low demanding patient rotational malalignment was noted and no further action needed.
Conclusion: According to the results of this study, the use of the Fixion nailing system, where indicated, is associated with minimal complications and very good functional outcomes in fractures OTA types A and B. The advantages of the expandable nail include the decrease in the operating and fluoroscopy time and the simplicity of its application.