The Universal Distractor: The Evolution of a Technique to Reduce Tibia Fractures

Abstract

A surgical technique has proven valuable in reducing and nailing tibial fractures, particularly those involving the proximal one third of the bone. Once reduction and nail insertion have been achieved, a distractor can be placed in a compression mode to determine whether static or dynamic locking is indicated. If the fracture pattern is axially unstable with compression, dynamic locking is contraindicated because of possible loss of reduction. This indirect reduction technique is performed on a fluoroscopy table, which avoids the potential complications associated with conventional fracture tables. The fluoroscopy unit remains in one orientation during the entire operation. Biplanar imaging is accomplished by moving the limb, not the C-arm fluoroscopy unit; hence, there is no redraping, and the surgeon's dependence on ancillary personnel is decreased. This technique expedites setup time, provides complete control over the involved extremity, facilitates accurate reduction, eliminates the diastasis often associated with these procedures, and simplifies interlocking. This technique is simple, safe, and accurate, and should be considered when treating unstable tibial shaft and proximal third tibial shaft fractures with a locked intramedullary nail.