Introduction and Aims: The management of diaphyseal tibial fractures remains controversial. This paper looks at the use of an innovative, unlocked, inflatable intra-medullary nail (Fixion, Disc-O-Tech). The study aim is to assess the performance of this nail relative to a traditional locked nail.

Method: This study compares a prospectively recruited cohort of patients treated with the fixion nail to a consecutive series of patients treated with the Russel Taylor locked nail prior to the introduction of the new device. All the fractures were classified using the AO system. Operating time and the x-ray screening time were recorded, along with any peri or post-operative complications, and need for secondary procedures. Follow-up x-rays were assessed for time to radiological union.

Results: Thirty-six patients were identified, 17 undergoing fixion tibial nailing and 19 having locked Russell Taylor nails. AO classification of fractures ranged from 42-A1 to 42-C3 and was similar in the two groups. In the Fixion group were 15 males and two females with an age range of 15 to 76 years. Two cases required secondary procedures. In the locked nail group were 19 cases, 16 males and three females. Eleven of the cases required secondary procedures, principally removal of locking screws for dynamisation of the nail in cases of delayed bone union and four patients had the nail removed.

The mean operating time for the fixion nail was 58 minutes and 89 minutes for the locked Russell Taylor nail, a statistically significant difference (p< 0.002, unpaired t-test). There was also a significant difference in the need for secondary procedures with at least one further procedure in 11/18 Russel Taylor nails and only 2/17 Fixion nails (p< 0.006, Fisher’s exact test). There was no significant difference in image intensifier screening time between the two groups. There was a trend to reduced time to bone union with the Fixion nail which did not reach statistical significance in this small cohort (p = 0.06), but may do so as a larger number of patients are studied.

Conclusions: Our results show that operative time was significantly less with the fixion nail, there were many fewer secondary procedures and all fractures went on to union. Our study demonstrates that an unlocked, inflatable nail compares favourably with a locked nail and should be considered in tibial diaphyseal fractures.