Distal Tibial Extra-Articular Intramedullary Nail Failed Fixation

Distal tibial extra-articular fractures may present difficulties to be reduced and to be stabilised with a load sharing device—intramedullary (IM) nailing. The surrounding soft tissue envelope of the distal tibia, particularly anteriomedially, is associated with a compromised blood supply to the bone and increased risk of wound-related problems that can lead to wound breakdown and development of secondary infection. Good reduction and optimum fixation are paramount to optimise patient outcomes. Failure of surgical treatment of extra-articular distal tibia fractures may have various aetiologies related to poor reduction, malalignment, mechanical instability and poor bone quality. Herein, a case of failure is presented discussing the aetiology of failure and the subsequent successful treatment plan implemented.