Distal Tibial Fracture Treatment with or without Shortened Intramedullary Nail

Abstract

Between 1990 and 2000 a total of 108 distal tibia fractures were treated with reamed interlocked intramedullary nailing in our Department. Ninety-four patients (63 male and 31 female), aged 16-81 years (mean 39 years), were found in the last follow-up. Seventy-eight patients had concomittant fractures of the lateral malleolus, and 4 had medial malleolar fractures. The AO-fracture classification system was used. Eight of the fractures (8.5 %) were open grade I, according to Gustillo’s classification. Closed reamed nailing was performed in all cases. Sixty-two A1 fractures (65.9 %) were distally locked (dynamic nailing) and 17 A2 and A3, 8 type B and 7 type C fractures were proximally and distally locked (static nailing). In fourteen cases the nail had to be modified, cutting the distal 1 cm. Lateral malleolus fractures were fixed before tibial nailing, in order to ensure fracture alignment. Mean hospitalization time was 6 days. Partial weight bearing begun after the 3^rd postoperative week in patients with concomittant malleolar fractures. The mean follow-up was 46 months (12-118 months). Union was achieved in 89 (94.6 %) fractures, within an average of 4.2 months (range: 3-10 months). Static nailing was converted to dynamic in 2 cases. There were four atrophic non-unions (2 %) and one deep infection (1.06 %) led to septic pseudarthrosis. Three patients with aseptic non-union were treated with nail dynamization and 1 required bone grafting and fibular osteotomy. Two patients (2.12 %) developed postoperative peroneal nerve palsy, which fully recovered. One patient developed deep posterior compartment syndrome leading to FHL contracture. Reamed interlocked intramedullary nailing is a reliable method of treating distal tibia fractures, with or without ankle joint involvement. When the metaphyseal fragment is short, a modified shortened tibial nail offers excellent functional and clinical results.

Key words

Reamed intramedullary nailing - Shortened nail - Distal tibial fractures

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