Loss of Reduction and Malunion After Cortical Perforation During Flexible Nailing of an Open Tibia Fracture

Tibial shaft fractures have a relatively high incidence in the pediatric population. There are numerous ways to address this trauma including external fixation, plate osteosynthesis, flexible nailing, and closed treatment with the selection of each modality depending on multiple factors, including fracture characteristics as well as potential adverse events. Flexible nailing is a method of treatment at our institution for displaced tibial shaft fractures in patients who are not obese, who are skeletally immature, and whose fractures are not amenable to closed treatment. One of the described complications of this treatment method is an angular deformity. In this case report, we present a valgus recurvatum malunion of a pediatric left open tibia and fibula diaphyseal shaft fracture in a 13-year-old female due to an accidental bicortical perforation of one of the nails without concomitant fixation of the fibula. The purpose of this paper is to present a surgical complication and how to avoid it.