INTRAMEDULLARY NAILING OF DISTAL METAPHYSEAL TIBIAL FRACTURES

Abstract

Purpose: This study was performed to evaluate the results of intramedullary nailing of distal tibial fractures located within 5 cm of the ankle joint.

Materials and Method: From 1990 to 2007, 142 tibial fractures that involved the distal 5 cm of the tibia were treated with reamed intramedullary nailing with use of either two or three distal interlocking screws. Twenty-one tibial fractures were open and were treated primarily with external fixation and then with intramedullary nailing.

Seventy patients (49%) were under 20 years old, 85 (59%) were men and traffic accident was the main cause of fracture in 58 (41%) patients.

108 patients were treated with GK nail, 14 patients with modified GK nail and 20 patients with S2 nail.

All patients were allowed postoperatively full weight bearing with crutches till the fracture healing. Patients were evaluated clinically and radiographs were reviewed every three weeks till fracture healing. Last follow-up was at two years postoperatively.

The functional results were evaluated with the Iowa Ankle-Evaluating System.

Results: Acceptable radiographic alignment, defined as < 5° of angulation in any plane, was obtained in 135 patients (95%). No patient had any change in alignment between the immediate postoperative and the final radiographic evaluation. We had no non-unions or failures of the implant.

Complications included one superficial infection at the entry point of the nail and one iatrogenic fracture at the time of the intramedullary nailing. The fractures united at an average of 12.5 weeks.

The functional outcome was determined at one and two years postoperatively.

There was improvement in the Iowa Ankle-Evaluating System scores with time.

Conclusion: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. Simple articular extension of the fracture is not a contraindication to intramedullary fixation. Functional outcomes improve with time.