Surgical treatment of distal tibia fractures with intra-medullary nail

Abstract

Introduction. Fractures of the distal tibia in the adult result from a combination of axial compression and rotational forces. Surgical treatment of extra-articular fractures of distal tibia is a controversial topic throughout the entire literature. The recent development of more distal locking options with IM nails and anatomically-contoured angle-stable plates have improved our ability to stabilise these fractures. Material and methods. This study included 27 patients admitted and treated for distal extra-articular tibial fractures (AO 43 A1-3) between Jan 2012 and May 2015 in the IInd Clinic of Orthopaedics and Traumatology. Ten patients sustained open fractures (two type I GA, four type II GA and four type IIIA GA). Nine patients also had distal peroneal or peroneal malleolus associated fractures and 18 had associated supra-malleolar fractures of the peroneus. IM nailing was the treatment choice for all cases (with reaming in 14 cases) and for the associated peroneal fractures ORIF with plates and screws was performed. Results. From a total of 27 cases, 4 (14,8%) cases healed with a varum>5o deformity, 3 (11,1%) cases developed pseudarthrosis that necessitated further surgical treatment (angular stable plates and bone graft), 1 (3,7%) case had intraarticular nail migration and infection, 19 (70,4%) cases had a favourable evolution with good outcome. All fracture healing complications appeared within the cases treated without medullary canal reaming and without associated distal peroneal fractures. Conclusions. Cases treated with ORIF for distal peroneal fractures had better results that those treated by conservative means. IM nailing can be extremely important in open fractures where it can provide excellent fixation of the fracture fragments and allows, if necessary, extensive debridement and reconstructive treatment for soft tissues without direct implant exposure. It was also noted that reamed nailing was biomechanically superior in terms of stability to the unreamed nails.