Extra articular metadiaphyseal fractures of distal tibia managed by tip locking intramedullary Nailing: A case series

Abstract

Introduction: Distal tibial fractures are commonest, often a result of high-energy trauma causing significant soft tissue injury and comminution. Being subcutaneous with tenuous soft tissue coverage it is poorly vascularized with more risk of infections, delayed union and non-union. This study is intended to know the efficacy of closed reduction with tip locking intramedullary nail, in distal extra articular metadiaphyseal tibia fractures with at least 4-5cm of intact distal fragment. Materials and Methods: This study is conducted on 18 skeletally mature patients, 14 male and 4 female, between December 2019 to December 2020 who fulfilled the inclusion criteria, using an Expert Tibial Nail System (ETNS)/tip locking IM nail. Patients were assessed clinically and radiologically at regular intervals for fracture union, functional ROM and any residual symptoms. Results: Average time of fracture union was 15.2 weeks. The functional ROM in majority of patients was as pretrauma level at end of 15.2 weeks without any complications and residual symptoms on full weight bearing. Evaluated American Orthopaedic Foot and Ankle Society (AOFAS) ankle score was 80.Conclusion: ETNS/tip locking IM nail is an excellent option in tackling distal tibia fractures. It is a minimal invasive biomechanical procedure, giving stability even in osteoporotic bone. Minimal soft tissue complications with advantage of early fracture union and ambulation.