Distal tibia fractures: when is nailing preferred?

Abstract

Background The treatment of distal tibia fractures remains controversial. Despite the well-known advantages of nailing, its use in distal tibia fractures has been reported to be associated with technical difficulties and high malalignment rates. Many surgeons are still hesitant to use nailing for distal tibia fractures. Objectives The aims of this prospective study were to evaluate the results of using static-reamed intramedullary nailing in the treatment of distal tibia fractures, and to define the situations in which nailing may be preferred. Patients and methods Between January 2008 and December 2011, 30 patients – 21 men and nine women – were treated in King Fahad Hospital at Al-Baha, KSA. Their mean age was 28.6 years. According to the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, 20 cases had type A, eight had type B, and two had type C fractures. Ten fractures were open: four type I, five type II, and one type III-A. The American Orthopedic Foot and Ankle Society ankle–hindfoot scale was used for assessment in this study. Results The mean follow-up time was 26.3 months. Three patients with open fractures got superficial infections. All the fractures united with acceptable alignment in a mean time of 15.74 months with two delayed unions. No difference in alignment was encountered between the immediate postoperative and final radiographs. Limb length discrepancy of 5 mm or less was encountered in one patient. Two (6.66%) patients had less than or equal to 10° reduced range of ankle motion. One (3.33%) patient lost his job, four (13.33%) patients did not return to their preinjury daily activity, and eight (26.66) patients stopped sports-related activities. Implant removal was carried out for three patients with knee pain. The mean American Orthopedic Foot and Ankle Society score was 93 at the end of follow-up. Conclusion Static-reamed nailing is a safe and effective biological stable fixation option in treating distal tibia fractures. Nailing may be preferred in uncontrollable patients, open fractures, osteoporotic bone, pathological fractures, obese patients, and when early weight-bearing is unavoidable. We did not recommend nailing for articular comminution, failure of closed reduction, and types III-B and III-C open fractures.