Distal Metaphyseal Fractures of Tibia Treated by Multiaxial Locked Intrameduallary Nail: A Study of 43 Cases

Abstract

Objective: To study and analyze the early results of metaphyseal fractures of the distal tibia fixed with multiaxial locked intra-medullary nail. Introduction: Intra-medullary nailing is considered gold standard for fixation of fractures of the shaft of tibia. However, fixation of distal tibial fractures with uniplanar locking intra-medullary nails pose problems of primary and/or secondary malalignment. The intra-medullary nail with multiple locking options in different planes is biomechanically a better option retaining the advantages of intra-medullary nailing and its minimally invasive technique for use in fractures of metaphysis of distal tibia. Methodology: Data for a cohort of 43 distal tibial metaphyseal fractures, treated with the multiaxial locked intra-medullary nail between July 2014 and November 2015 was collected. Closed and minimally open extra articular metaphyseal fractures of distal tibia were included. Union time, complications, ankle movements and radiographic alignment were analysed. At final follow-up (minimum 6 months), all patients were evaluated as per the Modified Karlstrom-Olerud scoring system. Results: The mean age of patients was 38 (Range 18-65) years with maximum (54%) of them being in the range of 18-35 years. Average time to union was 15.4 weeks. Although the patients showed equivocal results on grading against outcome score, 95.4% of the fractures united without any major significant complications.  Only 7% patients showed implant related complications. The change observed in primary and secondary alignment was not statistically significant. Ankle movements were either not affected or, at the most, mildly affected in nearly 80% of the cases.

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