Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement.

Abstract

To evaluate the efficacy of intramedullary nailing in diaphyseal tibia fractures with distal intraarticular involvement. Retrospective. Henry Ford Hospital, a level I trauma center. Twenty patients with twenty fractures at an average of twenty-two months of follow-up were evaluated. There were fifteen closed and five open fractures. All fractures were stabilized with lag screw fixation (with or without supplemental plates) of the intraarticular-fracture extension or ankle fracture, and intramedullary nailing of the diaphyseal tibia fracture. Time to bony union, malunion, knee and ankle range of motion, early arthrosis, and any complications of treatment were assessed. Nineteen fractures healed, with an average time to bony union of seventeen weeks. One nonunion after a grade IIIB open fracture required exchange nailing and healed after sixty-two weeks. Nineteen fractures had excellent alignment after healing. There were no infections. The indications for intramedullary nailing of unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.