INTRAMEDULLARY LOCKED NAIL FOR DISTAL TIB IAL FRACTURE

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.