Intramedullary fixation of distal tibial fractures around diametaphysis using locked intramedullary cannulated distal tibial nail a prospective study

Abstract

Purpose: There is no consensus on the best way of managing distal tibia dia-metaphyseal extra-articular fractures. To avoid the complications associated with other methods of fixation in these fractures we used intramedullary cannulated distal tibial nail for fixation, utilizing the advantages of nailing. We evaluated results, complications and mean time of fracture union. Method: A Prospective study of 26 patients treated with distal tibial nail in distal tibia dia-metaphyseal fractures, closed or open grade I to IIIb reporting within 3 weeks of injury. Grade IIIC open and dia-metaphyseal fractures lying within 2.5 cm from the ankle joint were excluded. Reamed and un-reamed technique of nailing were utilized for closed and open fractures respectively. Results: Average time of radiological union was 21.04 ± 9.44 weeks. Delayed-union reported in (3 of 26 cases). 25 of 26 cases achieved union without secondary procedure, one case required secondary procedure. Commonest complication was anterior knee pain (42%), valgus deformity was commonest in cases which had Mal-union. 85% of the patients had excellent to good result, one case had poor and 3 had fair result. Conclusion: Good to excellent results & low complication rate can be achieved by managing all dia-metaphyseal extra-articular fractures of distal tibia, by distal tibial nail with adjunctive fixation of concomitant fibular fractures if involves distal 1/3rd and also have syndesmotic instability.