Review Article

Functional Outcome of Extra-Articular Distal Tibia Fracture Treated with Tibia Interlocking Nail: A Case Series

Abstract

Background: Intramedullary interlocking nailing has emerged as one of the suitable management options for distal tibia fractures as it allows mechanical compression on weight-bearing, which stimulates bone healing. We studied 40 cases of extra-articular distal tibia fracture treated by intramedullary nailing.
Methods: We retrospectively studied 40 patients of both sexes above the age of 18 years with closed fractures and grade 1, 2, and 3A compound fractures treated at SVP Hospital, Ahmedabad, India. Clinically, the fracture was considered to be united when the patient was completely pain-free. Patients were followed up at monthly intervals till union. At each follow-up, patients were assessed both clinically and radiographically, and details were recorded based on proforma.
Results: The evaluation of the result was done using American Orthopedic Foot and Ankle Society (AOFAS) criteria. Thirty-three patients had excellent functional results, five had good functional results, and Two had fair functional results. In this study, 38 (95%) patients had radiological union within 24 weeks. Two patients had union after 28 weeks.
Conclusion: Intramedullary nailing is a minimally invasive procedure that preserves the soft tissue and the fracture hematoma. It maintains the length, alignment, and rotation and allows micromotion at the fracture site on weight-bearing, which stimulates callus formation. It has a good functional outcome with gratifying results when used in extra-articular distal tibia fractures.

1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130. [PubMed: 16814787].
2. Sarmiento A, Sharpe FE, Ebramzadeh E, Normand P, Shankwiler J. Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop Relat Res. 1995;(315):8-24. [PubMed: 7634690].
3. Russell TA. Fractures of the tibia and fibula. In: Rockwood CA, Green DP, Buckolz RW, Heckman JD, editors. Fractures in adults. 4th ed. Philadelphia, PA: Lippincott; 1996. p. 2139-57.
4. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746-50. doi: 10.1016/j.injury.2014.12.027. [PubMed: 25636535].
5. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):53. doi: 10.1177/107110079401500701. [PubMed: 7951968].
6.Hegazy G, Rashed RE, Al-shal EA, Hassan MA-E. Biological fixation of distal tibial fractures by locking compression plate. J Am Sci. 2015;11(5):179-84.
7. Padmanaban K, Kamalanathan M, Palaniswamy B, Ramasamy V, Cyriac AP. Prospective study of distal tibia fracture with anterolateral plating by MIPPO. Indian Journal of Orthopaedics. 2017;3(2):153-9. doi: 10.18231/2395-1362.2017.0030.
8. Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012;26(3):178-83. doi: 10.1097/BOT.0b013e31823924df. [PubMed: 22198653].
9. Bhairi N, Mahesh U, Qureshi A, Kumar S, Kumar M. Prospective study of surgical management of distal tibial fractures in adults. J Trauma Treat. 2017;6(375):2167-1222. doi: 10.4172/2167-1222.1000375.
10. Prakash M, Chaitanya G, Vamshidhar R, Veerla S, Mahesh T, Ramu C. Management of distal tibial pilon fracture with MIPPO. Annals of International Medical and Dental Research. 2017;3(4):24-9.
11. Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73(5):635-40. [PubMed: 18019921].
12. Paluvadi SV, Lal H, Mittal D, Vidyarthi K. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients. J Clin Orthop Trauma. 2014;5(3):129-36. doi: 10.1016/j.jcot.2014.07.010. [PubMed: 25983486]. [PubMed Central: PMC4223765].
13. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia-- results in 20 patients. Injury. 2006;37(9):877-87. doi: 10.1016/j.injury.2006.06.002. [PubMed: 16895727].
14. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24(1):24-9. doi: 10.1097/BOT.0b013e3181ac3426. [PubMed: 20035174].
15. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res. 1983;(178):7-25. [PubMed: 6883870].
16. Burc H, Dursun M, Orhun H, Gurkan V, Bayhan I. Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing. Acta Orthop Traumatol Turc. 2009;43(1): 7-13. [In Turkish]. doi: 10.3944/AOTT.2009.007. [PubMed: 19293610].
17. Radhakrishna AM, Shivananda S, Santhosh Kumar G. A clinical study of surgical management of diaphyseal fractures of tibia with intramedullary interlocking nail. Journal of Evolution of Medical and Dental Sciences. 2014;3(10):2478-91. doi: 10.14260/Jemds/2014/2161.
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IssueVol 10 No 3 (2024) QRcode
SectionReview Article
DOI https://doi.org/10.18502/jost.v10i3.16781
Keywords
Bone Nails Tibial Fractures Tibia
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How to Cite
1.
Patel I, Kavi S, Amin T, Modi D, Kantaria H, Masalawala H. Functional Outcome of Extra-Articular Distal Tibia Fracture Treated with Tibia Interlocking Nail: A Case Series. J Orthop Spine Trauma. 2024;10(3):111-4.