Osteosynthesis and Trauma Care 2003; 11: 120-122
DOI: 10.1055/s-2003-42312
Tibia

© Georg Thieme Verlag Stuttgart · New York

The Treatment of Distal Metaphyseal Fractures of the Tibia with a New Nailing System: Technical Advantages and Pitfalls

P. Vorlat1 , P. Haentjens1
  • 1Department of Orthopedics and Traumatology, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels, Belgium
Further Information

Publication History

Publication Date:
24 September 2003 (online)

Abstract

Aims: Distal metaphyseal fractures of the tibia are relatively frequent and form a separate group of lesions, because of difficulties with reduction and fixation of the distal fragment. As a consequence, most fixation techniques yield unsatisfactory results. We want to describe our experience with a new nailing system, putting emphasis on technical advantages and pitfalls.
Methods: Eight patients with distal metaphyseal fractures of the tibia were treated with the TriGen nailing system (Smith & Nephew, Memphis, TN, USA). The mean age of our patients was 50 years (range: 24 to 77 years). Of these 8 patients, 2 sustained an open fracture (Gustillo III a and III b). Reamed and unreamed techniques were used in 7 patients and 1 patient, respectively. No uniform strategy was adopted for distal locking.
Results: Technically, the particular design of this nailing system resulted in an unexpected advantage. The oval dynamic screw hole at the distal end of the nail helped to reduce varus malalignment of distal tibia in several fractures.
Both open fractures resulted in a non-union. In the first, only one screw was used for distal locking. The other was treated unreamed and the two distal screws were positioned in the frontal plane (parallel placement). The 6 closed fractures went on to uneventful healing within 3 months after injury. Two cases had a decreased mobility of the ankle joint.
Conclusion: For the treatment of distal metaphyseal fractures of the tibia, the particular design of the nail we used (oval hole at the tip of the nail) provides a possible technical advantage, which is helpful to reduce varus malalignment of the distal tibia. Based on our clinical experience we recommend systematic reaming, as well as using at least two crossed screws for distal locking, in order to enhance stability.

References

  • 1 Alho A, Ekeland A, Stromsoe K, Folleras G, Thoresen B O. Locked intramedullary nailing for displaced tibial shaft fractures.  J Bone Joint Surg [Br]. 1990;  72 805-809
  • 2 Bejui J, Carret J P, Fischer L P, Berger E, Bertrand H G, Lille R, Chadenson O, Benoit Y. [Critical study of nailing of the tibia with reaming and a closed focus. Apropos of a continuous series of 100 cases].  Rev Chir Orthop Reparatrice Appar Mot. 1982;  68 (Suppl 2) 126-130
  • 3 Bonnevialle P, Savorit L, Combes J M, Rongieres M, Bellumore Y, Mansat M. [Value of intramedullary locked nailing in distal fractures of the tibia].  Rev Chir Orthop Reparatrice Appar Mot. 1996;  82 428-436
  • 4 De La Caffiniere J Y, Benzimra R, Chanzy N. [Treatment of distal metaphyseal fractures of the tibia with the interlocking flexible osteosynthesis system].  Rev Chir Orthop Reparatrice Appar Mot. 1999;  85 42-50
  • 5 Dogra A S, Ruiz A L, Thompson N S, Nolan P C. Dia- metaphyseal distal tibial fractures - treatment with a shortened intramedullary nail: a review of 15 cases.  Injury. 2000;  31 799-804
  • 6 Hahn D, Bradbury N, Hartley R, Radford P J. Intramedullary nail breakage in distal fractures of the tibia.  Injury. 1996;  27 323-327
  • 7 Krettek C, Miclau T, Schandelmaier P, Stephan C, Mohlmann U, Tscherne H. The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails.  J Orthop Trauma. 1999;  13 550-553
  • 8 Krettek C, Stephan C, Schandelmaier P, Richter M, Pape H C, Miclau T. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails.  J Bone Joint Surg [Br]. 1999;  81 963-968
  • 9 Mabit C, Mallet T, Pecout C, Dunoyer J. [Recent isolated fractures of the tibia in the adult].  J Chir (Paris). 1985;  122 701-706
  • 10 Richter D, Hahn M P, Laun R A, Ekkernkamp A, Muhr G, Ostermann P A. [Ankle para-articular tibial fracture. Is osteosynthesis with the unreamed intramedullary nail adequate?].  Chirurg. 1998;  69 563-570
  • 11 Robinson C M, McLauchlan G J, McLean I P, Court-Brown C M. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing.  J Bone Joint Surg [Br]. 1995;  77 781-787
  • 12 Ruiz A L, Kealey W D, McCoy G F. Implant failure in tibial nailing.  Injury. 2000;  31 359-362
  • 13 Sarmiento A, Sharpe F E, Ebramzadeh E, Normand P, Shankwiler J. Factors influencing the outcome of closed tibial fractures treated with functional bracing.  Clin Orthop. 1995;  8-24

Peter VorlatM. D. 

Department of Orthopedics and Traumatology

Academisch Ziekenhuis

Vrije Universiteit Brussel

Laarbeeklaan 101

1090 Brussels

Belgium

Email: p.vorlat@worldonline.be