INTRAMEDULLARY NAILING OF UNSTABLE DIAPHYSEAL FRACTURES OF THE TIBIA WITH DISTAL INTRAARTICULAR INVOLVEMENT

Objective: To evaluate the efficacy of intramedullary nailing in diaph yseal tibia fractures with distal intraarticular involvement. Design: Retrospective. Setting: Henry Ford Hospital, a level I trauma center. Patients/Participants: Twenty patients with twenty fractures at an ave rage of twenty-two months of follow-up were evaluated. There were fift een closed and five open fractures. Intervention: All fractures were s tabilized with lag screw fixation (with or without supplemental plates ) of the intraarticular-fracture extension or ankle fracture, and intr amedullary nailing of the diaphyseal tibia fracture. Main Outcome Meas urements: Time to bony union, malunion, knee and ankle range of motion , early arthrosis, and any complications of treatment were assessed. R esults: Nineteen fractures healed, with an average time to bony union of seventeen weeks. One nonunion after grade IIIB open fracture requir ed exchange nailing and healed after sixty-two weeks. Nineteen fractur es had excellent alignment after healing. There were no infections. Co nclusions: The indications for intramedullary nailing bf unstable diap hyseal tibia fractures may be extended to include certain fractures wi th distal extension into the ankle joint, as well in a tibial shaft fr acture occurring in combination with a noncontiguous ipsilateral ankle fracture.