Interlocking Nailing of Dia-Metaphyseal Fractures of the Distal Tibia

Abstract

Thirty-nine patients with closed dia-metaphyseal fractures of the distal tibia, with or without minimally displaced extension into the ankle joint, were treated with closed, reamed, interlocking nailing. Eleven fractures were Robinson Type I, 23 Type II A, 3 Type II B and 2 Type II C. A fibular fracture was present in every Type I fracture and in 26 Type II fractures. Four Type I fractures and five Type II fractures had bone comminution. Supplemental procedures included reduction and fixation of the fibular fracture, percutaneous fixation of other malleolar fractures, and the use of Schanz screws or percutaneous forceps to aid in reduction of the fractured tibia. Seventeen fractures were nailed with an AO Universal nail shortened by removal of the distal 10 mm, and 22 fractures with a titanium AIM nail. Thirty-eight patients completed a prospective follow-up averaging 17 months (range: 12 to 38 months). All fractures united. Dynamization was required in 7 patients. There were few complications. Results were excellent in 13 patients, good in 21, fair in 3, and poor in 1. Thirty-three patients were restored to their preinjury status. Closed interlocking nailing of dia-metaphyseal fractures of the distal tibia, supplemented with reduction aids, is a reliable therapeutic procedure.