Evaluation of interlocking intramedullary nailing in distal tibial fractures and nonunions

Objectives: The aim of this study was to evaluate the re¬sults of interlocking intramedullary nailing in the treatment of extra-articular distal tibial fractures and nonunions. Methods: The study included 45 patients (mean age 42 years; range 27 to 52 years) who were treated with interlock¬ing intramedullary nailing for distal tibial fractures (n=35) and nonunions (n=10). Of 35 fractures, 31 were closed and four were open. The fractures were AO A1 (n=27), A2 (n=6), and A3 (n=2). In addition, two patients had medial, and 14 patients had lateral malleolus fractures. A Gross- Kempf (Howmedica) nail was used in 38 patients and an Expert nail (Synthes) was used in seven patients. Dynamic nailing was performed in 22 patients and static nailing was performed in 23 patients. No grafting was used. The patients were assessed clinically and radiographically within a mean follow-up period of 37 months (range 24 to 60 months). Results: Union was achieved in all the patients within a mean of 4.6 months (range 3 to 7 months). Dynamization was required in three patients. The mean time to union was 4.4 months (range 3 to 6 months) with dynamic nail¬ing and 4.8 months (range 3 to 7 months) with static nail¬ing. Complications were not serious. Transient peroneal nerve palsy developed in one patient (2.2%). Knee pain was seen in four patients (8.9%) due to the protrusion of the nail and it disappeared after removal of the nail. Five patients (11.1%) had limitation of ankle movements in a range of 5 to 10 degrees. None of the patients had restric¬tion in knee motion. Conclusion: Intramedullary interlocking nailing is a reliable method of treatment for distal tibial fractures and nonunions, with a high rate of union and low complication rate.