The Results of Closed Intramedullary Nailing for Intra-articular Distal Tibial Fractures

OBJECTIVES: To evaluate the long-term radiological, clinical, and functional result of the intramedullary nailing in intra-articular distal tibia fractures. DESIGN: Retrospective clinical study. SETTING: Level II Trauma Hospital. PATIENTS/PARTICIPANTS: Between December 2000 and December 2006, 185 consecutive intra-articular distal tibia fractures were admitted in our institution. Fifty fractures were included in the study. According to the OTA classification, there were 28 (56%) fractures type 43 C1 and 22 (44%) type 43 C2. INTERVENTION: All fractures were treated with closed static intramedullary nailing with distal locking. In 37 (74%) patients, reduction of the articular extension of the fracture with additional internal fixation preceded the nailing. Fibula fixation was applied in 32 (64%) fractures. Routine dynamization of the fixation was performed in all cases at a mean time of 10 weeks postoperatively. MAIN OUTCOME MEASUREMENTS: The mean follow-up was 42 months (range: 36-54 months). Leg length, tibia alignment, articular reduction, and ankle arthrosis were assessed radiographically. The clinical outcome was assessed using the Olerud-Molander score. The functional limitation was assessed using the musculoskeletal functional assessment. RESULTS: All fractures healed at an average of 16.3 weeks (range: 14-28 weeks). Anatomic reduction of the articular surface was obtained in all fractures. The average coronal plane deformity was 0.74 degree (range: 0-4 degrees) and the average sagittal plane deformity was 0.62 degree (range, 0-4 degrees). The mean Olerud-Molander score was 92.8/100 (range: 80-100). The average short musculoskeletal function assessment score was 34.55 ± 31.88 (range: 0.8-96). CONCLUSIONS: Intramedullary nailing augmented with minimal internal fixation is a safe alternative for the treatment of distal tibial fractures with a simple articular extension. Because all objectives of the treatment were obtained, the results did not deteriorate over time. LEVEL OF EVIDENCE: Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.