P. Bonnevialle et al., INTRAMEDULLARY LOCKED NAIL FOR DISTAL TIB IAL FRACTURE, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 82(5), 1996, pp. 428-436
Purpose of the study This study is a retrospective analysis of 38 extr
a-articular distal tibial fractures treated by intramedullary locked n
ailing. Patients and methods 38 patients with a distal metaphyseal ext
ra-articular fracture (43 A AO type) or with minimal ankle joint exten
sion were managed. There was 26 men and 12 women with a mean age of 32
.3 years, 10 fractures were open. The fractures were transverse or obl
ique in 13 cases, with torsionnal or flexion wedge in 12 cases and spi
roid in 13 cases. In only 2 cases was the fibula intact. AO classifica
tion was not useful because many fractures began more proximally than
the limit described by Muller, All the fractures were fixed by closed
locked intramedullary nailing : the nail was cut just after the distal
hole and impacted close to the subchondral plate. In 7 cases the fibu
la was fixed too. Results There was no postoperative complication in 2
7 cases. Three patients had a transient nerve palsy (one tibial nerve
and two common fibular nerve). In ten cases the nail was dynamized. On
e patient had a non union but healed with a new dynamic nail. Two pati
ents had a delayed union and healed after dynamization and osteotomy o
f the fibula. The mean time to union was 5 months (2 to 8). 8 patients
had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suff
ered from anterior knee pain and in 5 patiens the fracture site was pa
infull. In 18 patients a CT scan was performed : 6 had a rotational de
formity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy
of 7 and 9 mm). Conclusion Closed intramedullary nailing is a safe and
effective method for the treatment of distal metaphyseal tibial fract
ures. The authors propose a new classification.