The use of the Lottes nail in the treatment of closed and open tibial shaft fractures.

During the years 1979 through 1987, 98 patients with 101 acute tibial fractures were initially treated with Lottes' nails at the authors' institution. Ninety-one percent of the fractures healed uneventfully. The average healing times were 15.7 weeks for the 40 closed fractures and 20.5 weeks for the 61 open fractures. Infection occurred in one of the 40 closed fractures (2.5%) and in eight of the 61 open fractures (13.1%). By Gustilo grade, infection occurred in none of the 22 Grade I fractures (0%); one of the 22 Grade II fractures (4.5%); and seven of the 17 Grade III open fractures (41.2%). Seven of the eight malunions resulted from preventable technical errors. Five of the six nonunions healed after a secondary procedure. Lottes nailing is recommended in closed fractures and Grade I and II open fractures when internal fixation is required. Grade III open fractures, treated with the Lottes nail, had a high rate of infection.