Expert Nail in Management of Distal Tibial Fractures

Background: Fractures of the distal tibia are one of the most challenging injuries in orthopedic. Several methods have been described for the treatment of these fractures, including casting, external fixation, intramedullary nail and plate fixation. The choice of technique depends on multiple factors including fracture configuration, proximity to the plafond, bone quality, soft-tissue injury and available equipment. Non-operative management may be appropriate in some patients, particularly those with contraindications to anaesthesia. External fixation offers benefits in terms of soft-tissue management and in the management of severely comminuted fractures, but questions remain over the risks of infection and non-union. Intramedullary nailing may be effective in managing these fractures even with simple articular extension, but care needs to be taken with reduction and adequate distal locking to prevent malalignment and chronic knee pain may also be an issue. The aim of this work was to evaluate the results of locked intramedullary nailing in distal tibial shaft fractures clinically and radiologically. Methods: In this study 21 patients with closed distal tibial fractures treated in the period between October 2017 and October 2018 at Tanta University Hospital with intramedullary nail with multidirecrional distal locking screws (Expert tibial nail).The period of follow up ranged from 3 to 6 months with an average of 4.5 months. Results: The mean age of the patients was 36.38 years (range 20-59). The most commonly affected age group was20-30(38.1%). Males were more affected than females (76.2%). The most common mechanism of injury was motor vehicle accident (61.9%). According to Tenny & Wiss scoring systems for distal tibial fractures the clinical results were graded as excellent in six patients (28.6%), good in nine patients (38.1%), fair in four patients (19%) & poor in two patients (9.5%).The excellent and good results were considered as satisfactory results while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 15 patients (71.43%), and the unsatisfactory results were found in six patients (28.57%).There were some factors which affected the time of bone union: Younger age and patients not associated with medical conditions had rapid rates of union. This study encountered the following complications: nonunion in one patient (4.76%), delayed union in three patients (14.28%), sudeck's atrophy in three patients (14.28%), malunion in one patient (4.76%) and anterior knee pain in four patients (19.04%). Anteroir knee pain presented the most common complication. Youner and non-diabetic patients had rapid rates of bone union. Conclusion: Treatment of distal tibial fractures using intramedullary nail with multidirectional distal locking screws (Expert nail) is a safe and accepted method alternative to conventional nail and plating technique. It also provides greater preservation of the soft tissue and reduces varus/valgus or rotational deformity and lesser complications as metalwork irritation, infection and wound breakdown with the advantages of early weight bearing and good functional recovery.