Interlocking nail for management of distal tibia fracture: our experience at tertiary center of Bihar

Author(s): Dr. Wasim Ahmed, Indrajeet Kumar and Dr. Santosh Kumar

Abstract: Introduction: Tibia is the most commonly fractured bone amongst all long bones of the body due to its position and lack of soft tissue protection. Treating tibia distal 1/3rd fracture is still a greater challenge because Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site and have associated significant soft tissue injury. Generally, associated with ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, non-union, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it fixed to give stability to syndesmosis and stability to same-level tibia fracture.
Materials and methods: all patients of distal tibia fracture fulfilling the inclusion criteria from July 2011 to July 2017, were operated and followed up at every 4 weeks, till sign of union seen.
Results: 72 patients (male 40, female 32) with Mean age of was 35.2 years (20–50 yrs), Fracture union was seen radiologically within 12 to 20 weeks, depending on fracture geometry.
Conclusion: We found that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Careful planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is necessary to avoid varus, valgus, and antero-posterior tilt. Polar screw or temporary K-wire during surgery was found to be helpful. Same-level fibula fracture fixation with a plate or k-wire is effective for stability of reduction.

DOI: https://doi.org/10.22271/ortho.2018.v4.i2f.58