Intramedullary Nailing of Fractures of the Distal Tibia: A Borderline Indication

Abstract

The nailing of fractures in the distal part of the tibia, even those with intraarticular extension (certain type A, B1 and C1-fractures of the pilon: AO 43), is possible and a good alternative to open reduction and plate-osteosynthesis of the tibia. Only the distal fibula needs an open stabilization. This biological minimally invasive fracture treatment avoids extensive soft-tissue trauma and problems of wound healing. In a prospective study spanning two years (from 01.01.2000 until 31.12.2001) 30 fractures of the distal tibia, stabilized with an intercompression-nail (IC-nail, Stryker), were analyzed. No soft-tissue problems were seen, only in one case of a second degree open fracture a postoperative infection developed, which needed five revision operations with jetting and nail exchange. One rotational malalignment of 15 degrees needed a corrective osteotomy. Eight fractures (26.6 %) were dynamized after six weeks. In one case cancellous bone grafting was required. The time of hospitalization of patients with closed distal fracture treatment was less than nine days. Only in cases with open fractures or multiple injury a longer stay was necessary.

Key words

Intramedullary nailing - fracture of distal tibia and pilon - intercompression-nail

References

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