The Treatment of Distal Metaphyseal Fractures of the Tibia with a New Nailing System: Technical Advantages and Pitfalls

Abstract

Aims: Distal metaphyseal fractures of the tibia are relatively frequent and form a separate group of lesions, because of difficulties with reduction and fixation of the distal fragment. As a consequence, most fixation techniques yield unsatisfactory results. We want to describe our experience with a new nailing system, putting emphasis on technical advantages and pitfalls.
Methods: Eight patients with distal metaphyseal fractures of the tibia were treated with the TriGen nailing system (Smith & Nephew, Memphis, TN, USA). The mean age of our patients was 50 years (range: 24 to 77 years). Of these 8 patients, 2 sustained an open fracture (Gustillo III a and III b). Reamed and unreamed techniques were used in 7 patients and 1 patient, respectively. No uniform strategy was adopted for distal locking.
Results: Technically, the particular design of this nailing system resulted in an unexpected advantage. The oval dynamic screw hole at the distal end of the nail helped to reduce varus malalignment of distal tibia in several fractures.
Both open fractures resulted in a non-union. In the first, only one screw was used for distal locking. The other was treated unreamed and the two distal screws were positioned in the frontal plane (parallel placement). The 6 closed fractures went on to uneventful healing within 3 months after injury. Two cases had a decreased mobility of the ankle joint.
Conclusion: For the treatment of distal metaphyseal fractures of the tibia, the particular design of the nail we used (oval hole at the tip of the nail) provides a possible technical advantage, which is helpful to reduce varus malalignment of the distal tibia. Based on our clinical experience we recommend systematic reaming, as well as using at least two crossed screws for distal locking, in order to enhance stability.

Fracture fixation - intramedullary instrumentation - distal tibial fractures

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