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

Abstract

Eleven patients who sustained Pilon type A (according to AO classification) closed tibial fractures were treated with a modified G-K tibial nail. Two patients had sustained severe soft tissue damage around the ankle. The nail to be used was pre- selected by studying the X-rays of both the injured and the uninjured tibia. Subsequently, the nail was modified by cutting 1 to 1.5 cm off the distal end and creating an additional hole in between the pre-existing two distal holes. In this way it was possible for, at least, two screws to be inserted distal to the fracture line. The operative technique was also modified to accommodate the technical difficulties encountered during the first two cases. Poller screws were used in two cases. There were no intra- or post- operative complications. All fractures united soundly from 14-20 weeks. The patients regained full range of motion of the ankle joint and returned to the pre-fracture level of activity. Intramedullary nailing can provide a reliable treatment option for the type A Pilon fractures of the tibia. Alterations of the operative technique are necessary for a successful result.

Key words

Pilon A tibial fractures - intramedullary nailing

References

• 1 Collinge C, Sanders R, Di Pasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques.  Clin Orthop. 2000;  375 69-77
• 2 De la Caffiniere J Y, Benzimra R, Chanzy N. Treatment of distal metaphysial fractures of the tibia with the interlocking flexible osteosynthesis system.  Rev Chir Orthop Reparatrice Appar Mot. 1999;  85 (1) 42-50
• 3 Dogra A S, Ruiz A L, Thompson N S, Nolan P C. Dia-metaphyseal distal tibial fractures - treated with a shortened intramedullary nail. A review of 15 cases.  Injury. 2000;  31 799-804
• 4 Gorczyca J T, McKale J, Pugh K, Pienkowski D. Modified tibial nails for treating distal tibia fractures.  J Orthop Trauma. 2002;  16 (1) 18-22
• 5 Helfet D L, Shonnard P Y, Levine D, Borrelli Jr. J. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 1997; 28 Suppl 1: A42-7; discussion A47-8
• 6 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 (8) 550-553
• 7 Moshreiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures.  Injury. 1999;  30 (2) 83-90
• 8 Robinson C M, Mc Lauchlan G J, Mc Lean I P, Court 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 (5) 781-787
• 9 Stedtfeld H W, Taruttis H. Extrem distale Querbohrung des Tibiaverriegelungsnagels - eine wertvolle technische Variante.  Hefte zu der Unfallchirurgie. 1993;  230 (6) 909-915
• 10 Tscherne H, Gotzen L. Fractures with soft tissue injuries. Springer, Berlin, Heidelberg, New York 1984
• 11 Tyllianakis M, Megas P, Giannikas D, Lambiris E. Interlocking intramedullary nailing in distal tibial fractures.  Orthopedics. 2000;  23 805-808