Use of Intramedullary Nail in Distal Metaphyseal Fractures of Tibia

Background: The ideal treatment of distal metaphyseal tibia fractures is still controversial. With the development of extremely distal locking multidirectional holes, the application of intramedullary nailing has extended to the treatment of distal metaphyseal tibial fractures. The aim of the study was to evaluate the results of interlocking intramedullary nailing in extra-articular distal metaphyseal fractures of tibia. Patients and Methods: The study had been done in Mahatma Gandhi Medical College and Research Institute, Department of Orthopaedics. It included 15 patients with age ranging from 25 to 50 (mean 38), who were treated with interlocking intramedullary nailing for distal metaphyseal tibia fractures. About 13 cases were closed and two cases were compound. According to AO classification 12 cases were A1, two cases were A2 and one case was A3. All are due to road traffic accident. 12 patients had concomitant fibula fractures. In all cases, tibial nail with multiple multidirectional distal holes was used. 12 cases were locked dynamically and three cases (AO A2 and A3) were locked statically. Patients were followed up clinically and radiologically with mean follow-up of 16 months (12-20 months). Results: Union was achieved in all patients within a mean of 5 months (4-8 months). No serious complication was noticed. One patient (6.67%) had knee pain which was due to a protrusion of nail that subsided after nail removal. Two patients (13.33%) had the limitation of ankle range of motion in magnitude of 5-10°. One patient (6.67%) had valgus malalignment of 5°. No rotational malalignment was found in any patients. Shortening of 1.5 cm was found in single patient (6.67%). Conclusion: Intramedullary interlocking nailing is a reliable method of treatment for distal metaphyseal tibial fractures with a high union rate and low complication rate.