Osteosynthesis and Trauma Care 2004; 12(4): 203-207
DOI: 10.1055/s-2004-820356
Original Article

© Georg Thieme Verlag Stuttgart · New York

Interlocking Nailing of Dia-Metaphyseal Fractures of the Distal Tibia

A. Barquet1 , 2 , D. Rienzi1 , 2 , L. López1 , 2 , O. Mígues1 , 2 , J. Fregeiro1 , 2 , G. Mayora1 , 2
  • 1University Clinic of Traumatology and Orthopaedics, Montevideo, Uruguay
  • 2Centre for Osteosynthesis, AESM, Montevideo, Uruguay
Further Information

Publication History

Publication Date:
30 November 2004 (online)

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.

References

  • 1 Agnew S G, Henley M B. Reamed and unreamed nailing of tibial fractures. In: Browner BD (ed). The Science and Practice of Intramedullary Nailing. Williams & Wilkins, Media 1995; pp 209-225
  • 2 Anglen J O, Blue J M. A comparison of reamed and unreamed nailing of the tibia.  J Trauma. 1995;  39 351-355
  • 3 Athanasiou V, Megas P, Zouboulis P, Lambiris E. Distal tibial fracture treatment with or without shortened intramedullary nail.  Osteo Trauma Care. 2002;  10 217-220
  • 4 Bonnevialle P, Savorit L, Combes J M, Rongieres M, Bellumore Y, Mansat A. Value of intramedullary locked nailing in distal fractures of the tibia.  Rev Chir Orthop. 1996;  82 428-436
  • 5 Boos N, Bugyi L. Results of locking intramedullary nailing in distal tibial shaft fractures.  Unfallchirurg. 1989;  92 453-458
  • 6 de la Cafffinière J Y, Benzimra R, Chanzy N. Treatment of distal metaphyseal fractures of the tibia with the interlocking flexible osteosynthesis system.  Rev Chir Orthop. 1999;  85 42-50
  • 7 Dogra A S, Ruiz A L, Thompson N S, Nolan P C. Dia-metaphyseal distal tibial fractures - treatment with a shortened intramedullary nail. A review of 15 cases.  Injury. 2000;  31 799-804
  • 8 Duda G N, Mandruzzato F, Heller M, Goldhahn J, Moser R, Hehli M, Claes L, Haas N P. Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing.  J Biomech. 2001;  34 639-650
  • 9 Ekeland A, Thoresen B, Alho A, Stromsoe K, Folleras G, Haukebo A. Interlocking intramedullary nailing in the treatment of tibial fractures. A report of 45 cases.  Clin Orthop. 1988;  231 205-215
  • 10 Gäbler C, Tschegg E, Greitbauer M, Stanzl-Tschegg S, Wozasek G E, Laube W, Vécsei V. Fatigue stability of locking screws for unreamed tibial intramedullary nailing.  Unfallchirurg. 1999;  102 29-34
  • 11 Garnavos C, Balbouzis T, Papangeli E, Stavropoulos K, Giannoulatos C, Kanakaris N, Mitseas A. Intramedullary nailing with a modified nail and alterations of the operative technique for the management of type A pilon fractures of the tibia: a prospective study.  Osteo Trauma Care. 2003;  11 24-28
  • 12 Hahn D, Bradbury N, Hartley R, Radford P J. Intramedullary nail breakage in distal fractures of the tibia.  Injury. 1996;  27 323-327
  • 13 Helfet D, Shonnard P Y, Levine D, Borrelli J. Minimally invasive plate osteosynthesis of distal fractures of the tibia.  Injury. 1997;  28 (Suppl 1) SA 42-SA 48
  • 14 Krämer H. Die extrem distale Tibia-Verriegelungnagelung.  Osteo Int. 1995;  4 271-274
  • 15 Krettek C, Miclau T, Schandelmaier P, Stephan C, Mohlmann U, Tscherne H. The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails.  J Orthop Trauma. 1999;  13 550-553
  • 16 Kyro A. Malunion after intramedullary nailing of tibial shaft fractures.  Ann Chir Gynaecol. 1997;  86 56-64
  • 17 Moscato M, Sabetta E, Tigani D, Mignani G, Spechchia L, Boriani S. Grosse-Kempf nailing in fractures of the tibia.  Ital J Orthop Traumatol. 1991;  17 313-320
  • 18 Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures.  Injury. 1999;  30 83-90
  • 19 Raschke M J, Offmann R, Khodadayan C, von Fournier C, Südkamp N P, Haas N P. Combination of the Ilizarov ring fixator with the unilateral AO tube fixator. Initial clinical experiences with the hybrid system.  Unfallchirurg. 1995;  98 627-632
  • 20 Robinson C M, McLauchlan G J, McLean I P, Court-Brown C M. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing.  J Bone Joint Surg [Br]. 1995;  77 781-787
  • 21 Ruiz A L, Kealey W DC, McCoy G F. Implant failure in tibial nailing.  Injury. 2000;  31 359-362
  • 22 Richter D, Hahn M P, Laun R A, Ekkernkamp A, Muhr G, Ostermann P A. Ankle para-articular tibial fracture. Is osteosynthesis with the unreamed intramedullary nail adequate?.  Chirurg. 1998;  69 563-570
  • 23 Rzesacz E H, Konneker W, Reilmann H, Culemann U. Combination of intramedullary nail and covered screw osteosynthesis for managing distal tibial fracture with ankle joint involvement.  Unfallchirurg. 1998;  101 907-913
  • 24 Schmidgen A, Naumann O, Wentzensen A. A simple rapid method for removal of broken unreamed tibial nails.  Unfallchirurg. 1999;  102 975-978
  • 25 Schnettler R, Borner M, Soldner E. Results of interlocking nailing of distal tibial fractures.  Unfallchirurg. 1990;  93 534-537
  • 26 Stromsoe K, Eikvar K, Loken S, Ovre S, Hvaal K. Miniinvasive plate osteosynthesis of distal tibial fractures.  Tidsskr Nor Laegeforen. 1999;  119 4316-4318
  • 27 Tyllianakis M, Megas P, Giannikas D, Lambiris E. Interlocking intramedullary nailing in distal tibial fractures.  Orthopaedics. 2000;  23 805-808
  • 28 Vécsei V, Scharf W, Hertz H. Use of the interlocking nail for the treatment of distal diaphyseal fractures of the lower leg.  Unfallheilkunde. 1980;  83 54-59
  • 29 Vécsei V, Seitz H, Greitbauer M, Heinz T. Borderline indications for locked intramedullary nailing of femur and tibia.  Orthopäde. 1996;  25 234-236
  • 30 Vorlat P, Haentjens P. The treatment of distal metaphyseal fractures of the tibia with a new nailing system: technical advantages and pitfalls.  Osteo Trauma Care. 2003;  11 S120-S122

Prof. Dr. A. Barquet

Av. Sarmiento 2369

Apto. 301

11300 Montevideo

Uruguay

Phone: +5 98/2-7 10-68 84

Fax: +5 98/2-7 12-25 98

Email: antbar@adinet.com.uy

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