Abstract
This case presentation highlights the problem of thermal necrosis of the tibia following reaming, in a tibia with a narrow canal.
A 2 year follow up of a 19 yr old aspiring dancer, who had a closed low velocity fracture to her midshaft left tibia. This was treated with intramedullary nailing of the tibia. Difficulty encountered while reaming of the canal at the time of operation because of the narrowness of the canal. She subsequently had a refracture of the shaft of the tibia, above the united fracture after the removal of the intramedullary nail. This happened in the narrow isthmic part of the tibia proximal to the fracture and was confirmed to have avascularity with isotope bone scan. This subsequently showed no appreciable sign of healing.
Patient had renailing of the tibia with bone grafting and the fracture. Latest review shows the fracture to be consolidating.
Surgeons have to be aware of the dangers of narrow canal in tibia before intramedullary nailing and appropriate reamers to be used if the canal is too narrow.
The abstracts were prepared by Jean-Claude Theis. Correspondence should be addressed to him at Department of Orthopaedic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
