Determining distal tibial valgus or varus during treatment of distal tibial farctures with intramedullary nails

Abstract

Objective To explore how to determine distal tibial valgus or varus during treatment of distal tibial fractures with intramedullary nails. Methods Between January 2014 and January 2015, 27 distal tibia fractures were surgically treated with intramedullary nails at our department. They were 19 men and 8 women, aged from 22 to 76 years(average, 44. 6 years). Anteroposterior and lateral radiographs were taken in the course of preoperative radiological evaluation. To determine distal tibial valgus or varus, the parallel relationship between the distal horizontal interlocking nail and the ankle joint was examined in the anteroposterior X-ray films. Results The 27 patients were followed up for 12 to 24 months(average, 18. 3 months). The fractures healed after 3. 2 to 6. 7 months(average, 4. 5 months). The intraoperative measurement found 19 normal cases, 6 cases of valgus and 2 cases of varus. The abnormal cases were all corrected accordingly. At 2 days after surgery, the lateral angle of the distal tibia ranged from 87. 4° to 89. 2°(average, 88. 3° ± 0. 9°)at the normal side, from 87. 6°to 90. 2°(average, 88. 9° ± 1. 3°)at the affected side, showing no significant difference(P> 0. 05). According to the AOFAS ankle-hindfoot score at 12 months post-surgery, 18 cases were excellent, 6 good, 2 fair, and one poor, giving an excellent to good rate of 88. 9%. Conclusions The distal tibial valgus or varus can be determined during operation using the angle between the distal horizontal interlocking nail and the ankle joint in anteroposterior X-ray films. This effective technique can lead to timely treatment of the distal tibial valgus or varus. Key words: Tibial fractures; Fracture fixation, intramedullary; Clubfoot; Valgus; Varus

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