Publication:

Evaluation of the clinical, functional and radiological outcomes in patients with distal tibia fractures with simple intra-articular extension treated with intramedullary multidirectional locking nail: a prospective study

Background Distal tibia fractures with extension into the ankle joint (AO/OTA type 43C) poses challenge for an orthopedic surgeon, due to its subcutaneous nature and precarious blood supply. Literature has described various treatment modalities; most commonly used being locking compression pates, external fixators and intramedullary multidirectional locking nails.

Methods This prospective study included 60 patients with distal tibia fracture AO type 43C1 and 43C2, managed with intramedullary multidirectional locking nails in a close manner, with intra-articular fragment fixation preceding the nail insertion. The aim of this study was to evaluate the clinical, functional and radiological outcomes as well as the complications in these patients.

Results Patients’ mean age was 48.7±16.6 years; most had type 43C1 fractures (51 patients). The mean surgery time was 88.4±17.5 minutes, performed within 5.6±2.01 days post-injury. The 30 patients had fibula fracture with syndesmotic injury which was fixed with TENS nail. The functional assessment with Johner and Wruh’s criteria; 45 patients (75%) had excellent, 12 patients (20%) had good and 3 patients (5%) had fair outcomes. The fracture union averaged 16.7±1.63 weeks (14-20 weeks). 6 patients had superficial wound complication, while 3 patients had valgus malalignment; all managed without further surgery.

Conclusions Intramedullary nailing following specific surgical technique, and potential percutaneous screws; is a safe, effective and successful treatment option for AO/OTA types 43C1 and 43C2 fractures with high fracture union rates, high functional results, and low complication rates.