DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20211900

Study on management of extra articular distal tibial metaphyseal fractures by intramedullary interlocking nailing

A. Palanivel

Abstract


Background: Fractures of the tibia remain a controversial subject despite advances in both non-operative and operative care. The goal in expert care is to realign the fracture, realign limb length, and early functional recovery. To analyze the short-term results of intramedullary interlocking nailing in the management of extra-articular distal tibial metaphyseal fractures done.

Methods: This is a prospective comparative on-randomized study of 28 patients with distal tibial metaphyseal fractures in govt. dist. headquarters hospital Nagapattinam with a follow-up ranging from September 2018 to january 2019 4 months. Injury With more than 3 weeks, nonunion, and patient with multiple injuries or a history of previous knee or ankle pathology were not included as were patients who sustained high energy axial load injury-causing disruption or impaction of the ankle plafond.

Results: The average distance between the distal tip of the nail and the articular surface of the plafond was 12 mm (range, 4 to 15 mm). Fibular plating was done in 10 patients. Two distal locking bolts were used in 26 patients; 2 patients had three distal locking bolts.

Conclusions: Intramedullary nailing is a safe and effective technique for the treatment of extra-articular distal metaphyseal tibial fractures if careful preoperative planning is allied with the meticulous surgical technique.


Keywords


Distal tibia fractures, Extra-articular, Pilon fractures, Interlocked nailing

Full Text:

PDF

References


Alberts KA, Loohagen G, Einarsdottir H. Open tibial fractures: faster union after un-reamed nailing than external fixation. Injury. 1999;30:519.

Bechtold JE, Kyle RF, Perren SM. Biomechanics of intramedullary nailing, in Browner B, Edwards C (eds): The Science and Practice of Intramedullary Nailing. Philadelphia, PA: Lippincott Williams and Wilkins. 1987;89-101

Blachut PA, O’Brien PJ, Meek RN, Broekhuyse HM. Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft: A prospective, randomized study. J Bone Joint Surg Am. 1997;79:640-6.

Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and effects of different plating techniques: A human cadaveric study. J Orthop Trauma. 2002;16:691-5.

Bourne RB. Pylon fractures of the distal tibia. Clin Orthop Relat Res 1989;240:42-6.

Chen AL, Tejwani NC, Joseph TN, Kummer FJ, Koval KJ: The effect of distal screw orientation on the intrinsic stability of a tibial intra medullary nail. Bull Hosp Jt Dis. 2001;60:80-3.

Dogra AS, Ruiz AL, Thompson NS. Dia-metaphyseal distal tibial fractures: treatment with a shortened intra medullary nail: a review of 15 cases. Injury. 2000;31:799-804.

Fan CY, Chiang CC, Chuang TY, Chiu FY, Chen TH. Interlocking nails for displaced metaphyseal fractures of the distal tibia. Injury. 2005;36(5):669-74.

Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intra medullary nailing. Clin Orthop. 1995;315:25-33.

Goh JC, Mech AM, Lee EH, Ang EJ, Bayon P. Biomechanical study on the load-bearing characteristics of the fibula and the effects on fibular resection. Clin Orthop Relat Res. 1992;279:223-8.

Gorczyca JT, McKale J, Pugh K, Pienkowski D. Modified tibial nails for treating distal tibia fractures. J Orthop Trauma. 2002;16:18-22.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453-8.

Keating JF, O’Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intra medullary nailing with and without reaming for open fractures of the tibial shaft: A prospective, randomized study. J Bone Joint Surg Am. 1997;79:334-41.

Kneifel, Buckley R. Acomparison of one versus two distal locking screws in tibial fractures treated with undreamed tibial nails. A prospective randomized clinical trial. Injury. 1996;27:271-3.

Konrath G, Moed BR, Watson JT, Kaneshiro S, Karges. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intra articular involvement. J Orthop Trauma. 1997;11:200-5.

Krettek C, Stephan C, Schandelmaier P, Richter, Pape HC, Miclau T. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter intra medullary nails. J Bone Joint Surg Br. 1999;81:963-8.

Kumar A, Charlebois SJ, Cain EL, Smith RA, Daniels AU, Crates JM. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intra medullary nailing. J Bone Joint Surg Am. 2003;85:604-8.

Martin JS, Marsh JL, Bonar SK, De-Coster TA, Found EM, Brands EA. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma. 1997;11:477-83.

Mast J, Jakob R, Ganz R. Planning and Reduction Technique in Fracture Surgery. New York, NY: Springer-Verlag. 1989.

Merchant TC, Dietz FR. Long-term follow-up after fractures of the tibial and fibular shafts. J Bone Joint Surg Am. 1989;71:599-605.

Morrison KM, Ebraheim NA, Southworth SR, Sabin JJ, Jackson WT. Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia. Clin Orthop. 1991;266:209-13.

Mosheiff R, Safran O, Segal D, Liebergall M. The un-reamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999;30:83-90.

Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation, 3rd ed. Heidelberg, Springer-Verlag. 1991.

Muller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin, Germany: Springer-Verlag, 1990.

Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intra medullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87(6):1213-21.