Closed intramedullary nailing of the tibia is a well accepted method of treating tibial fractures. There are advantages to perfoming surgery via smaller incisions. These advantages include less muscle dissection, less pain, less blood loss and quicker recovery and discharge from hospital and improved cosmesis.

We have used an existing tibial nail (Zimmer M/DN) to carry out percutaneous nailing of tibial shaft fractures using a modified surgical technique. This report describes the operative technique and our early results.

We have used this technique in 10 patients. The main difference in the technique is the use of a Steinman pin under fluoroscopy to identify the entry point. The average incision length in these patients has been 2.5cm. We have had no early or medium term complications. Length and rotation was restored in all cases. There was no increase in the surgical time or fluoroscopy time for the operation. Post-operative analgesic use was significantly less in these patients when compared with the standard technique. The average length of hospital stay has been reduced by 25% in this early cohort.

The rate of litigation following personal injury is rising at an exponential rate with no concomitant rise in the actual incidence of these injuries. It is recognised that physical injury can lead to mental health disturbance and such mental health disturbance can delay recovery following injury. No previous study has assessed the incidence of pre-existing mental health morbidity amongst personal injury claimants.

The general practitioners records of 750 consecutive personal injury claimants were examined. Mental health diagnoses prior to the index injury were noted and classified using the Diagnostic and Statistical Manual of the American Association of psychiatry. Any treatment by mental health professionals was noted.

A highly significant excess of pre-injury psychiatric morbidity was identified in the study population. There was a 40% incidence of at least one mental health diagnosis. There was a highly significant excess of depression and anxiety. 10% of the study group had received treatment from at least one mental health professional.

Pre-existing psychiatric morbidity appears to be an independent predictive factor for pursuing litigation following personal injury. In light of existing knowledge that such psychiatric morbidity often results in prolongation of physical symptoms and poor response to standard treatment regimes, it is important to recognise such patients when providing a prognosis in a medico-legal context.