Background: We present our further experience with the Orthofix tibial nailing system, concurrently evaluating the easy and safety of the distal targeting system for the distal locking.

Materials & Methods: Ninety-seven fresh tibial fractures in the same number of patients with a mean age of 38,5 years (17–85) were treated. Three were lost from the follow-up. Twenty of the fractures were grade I open fractures, four grade II and one grade IHA. All operations were performed in a conventional operating theater on a simple transparent operating table, with reduction of the fracture performed under manual traction and manipulation of the fracture site, hi most of the cases closed reduction was achieved and conventional reaming performed; in 14 patients the fracture was reduced through a small incision at the fracture site. Conventional reaming (power reaming) was performed in 69% of the patients; however, in 31% of the cases (30 patients), only minimal hand reaming was performed. The mean duration of the operation was 30 min. The external targeting device failed in 10 distal locking screws, in six of which the second attempt was successful. In four an image intensifier had to be used.

Results: Fracture healing, confirmed clinically and radiographically, was observed at a mean of 17 weeks (12–28 weeks). No tibial non-union necessitating reoperation occurred, however six fractures showed delayed union. Open reduction didn’t compromise the healing of the fracture. All patients eventually gained a full range of motion knee and ankle joint and only twelve of them (12%) complained of mild anterior knee pain. All patients returned to their previous activity, except for one disabled from a head injury. The later evaluation showed preservation of the tibial axis in all patients and additionally that no mechanical failure of either the nail or the screws occurred.

Conclusions: We conclude that the Orthofix nailing system is a clinically effective system. Distal locking can be performed with ease without significant exposure to radiation, provided that the operative technique is accurately followed, the nail is inserted without significant force and the distal targeting device is not subjected to any violation, such as hammering.