Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures - 06/11/14

Doi : 10.1016/j.otsr.2014.09.012

P. Boyer ^⁎ , P. Charles, P. Loriaut, J. Alkhaili, G. Mylle, A. Pelissier, P. Massin
Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique–Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France

^⁎Corresponding author.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 06 November 2014
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Abstract

Introduction

Intramedullary nailing in distal tibial fracture is controversial because of a lack of stability. The present study sought to assess radiological and clinical results for a new “angular-stable” locking system in difficult indications for intramedullary nailing.

Material and method

A prospective study recruited 41 patients (41 tibias) with distal tibial fracture consecutively managed using angular-stable locked intramedullary nails. Radiologic assessment comprised AP and lateral lower-limb views, taken postoperatively and through to last follow-up. The mean distance was measured between fracture and joint line. Fusion, with or without malunion, primary reduction defect, non-union and secondary displacement were recorded, as were all complications.

Results

Mean follow-up was 18±5 months; 3 patients were lost to follow-up. Mean fracture distance from the joint line was 63±25mm. Fusion was achieved within 3 months in 29 cases (76%); delayed fusion in 7 patients (18%) required secondary dynamization at a mean 3 months, with favorable evolution. Revision surgery was required in 2 cases: 1 for secondary displacement exceeding 10°, and 1 for non-union at 7 months. Other complications mainly comprised 4 malunions of less than 10° due to primary reduction defect.

Conclusion

Angular-stable locked lower-limb intramedullary nailing provided a very satisfactory fusion rate, with few complications. It is, however, a demanding procedure, especially as regards fracture reduction and nail positioning in the distal fragment.