Case report: An 83-year-old woman presented with a high-energy tibial fracture. We treated her with temporary external fixation and delayed flexible intramedullary nailing because of extensive soft-tissue damage and interference from the hardware retained from a previous total knee arthroplasty.
Conclusions: In our opinion, flexible intramedullary nailing is an effective procedure and provides good functional and radiological results in high-energy tibial fractures with extensive soft-tissue loss.