The unreamed tibial nail in the treatment of distal metaphyseal fractures

In recent years biological surgical solutions have been recommended in case s of distal tibial fractures, with the aim of reducing damage to soft tissu es and to bone vascular supply. Between the years 1991-1995, 52 patients su ffering from fractures of the distal tibial metaphysis were treated in our department with an unreamed tibial nail (UTN). Fractures were categorized i n accordance with the AO Classification. 32 fractures had no articular invo lvement (43A1, 43A2, 43A3) and 20 included intraarticular extension (43C1, 43C2). 32 fractures had significant metaphyseal comminution (43A2, 43A3, 43 C2). 12 were open fractures. All the fractures were treated by means of UTN using distal locking. In 13 patients an additional percutaneous interfragm entary fixation was also applied. 22 patients underwent an additional opera tion in order to facilitate bone union (dynamization, bone:grafting and/or fibulectomy). In 50 of the 52 patients the fracture united with a very good range of knee and ankle motion. In 2 patients non-union with breakage of t he UTN occurred and in two open fractures post-operative infections were ob served. Our experience with the treatment of fractures of the distal tibia, includi ng intra-articular fractures with no comminution, points at an excellent fu nctional outcome with a low incidence of complications. (C) 1999 Published by Elsevier Science Ltd. All rights reserved.