Intramedullary Nailing of a Multilevel Tibial Fracture: The Role of Axial Stability in Avoiding Adjunctive Fixation

Background: Fractures of the tibia that involve both the proximal and distal segments presents with specific biomechanical issues. While plating remains the treatment of choice for fractures of the distal tibia, this case illustrates the application of intramedullary (IM) nailing as the definitive treatment for an axially stable comminuted distal tibial fracture associated with a tibial shaft fracture. Case presentation: The patient presented with pain on the right leg after sustaining injury by MTA as a passenger, Preoperative imaging revealed a stable comminuted tibia fracture with an associated oblique tibial shaft fracture and fibular fracture. Conclusion: The case illustrates that IM nailing alone, without supplemental fixation, is appropriate for treating axially stable, multilevel tibial fractures which possess inherent stability. It highlights the need for careful preoperative evaluation of the fracture pattern and challenges the use of blocking screws or fibular fixation in selected cases.