Management of distal tibial metaphyseal fractures by expert tibial nail

Introduction: Distal tibial metaphyseal fractures causes extensive musculoskeletal damage and needs an accurate fixation with minimal soft tissue damage. The optimal method of fixation remains debatable. Open reduction and internal fixation cause devascularizing fracture fragments with soft tissue and skin problems. Intramedullary nailing interlocking tibial nails are reported with high complication rates. Expert Tibia Nail (ETN) provides an alternative to these fractures. We studied the efficacy of the ETN in treating distal tibial metaphyseal fractures. Materials and Method: We did a retrospective analysis of distal tibial metaphysic fractures treated with ETN done between June 2010-May 2012. 72 patients with AO type 4.3. A1, A2, A3 were included in the study. The outcome was assessed based on fracture union, fracture alignment, range of knee and ankle movements, secondary procedure rate and postoperative complications within 1yr. Results: The average time of fracture healing was 16 wks. Delayed union was seen in 11.11%. Reoperation rate including dynamisation was 12.5%. Primary malalignment was reported in 6.9% of the cases and 2.7% had secondary malalignment. Majority of patients had good to excellent knee and ankle range of motion. Four patients had wound dehiscence and 3 had infections. Discussion: The results of our study validate the efficacy of ETN in distal tibial metaphyseal fractures. Fracture union was demonstrated in about 90% of the cases within 6 months of surgery and all patients achieved fracture union within 1 year after surgery. Stability and alignment of fracture were achieved with an additional fixation of fibula without increasing risk of delayed union. Expert tibia nail due to its multiplanar locking options, locking option at the tip of nail, provides angular stability. Conclusion: ETN provides stable internal fixation, early ROM knee and ankle, provides angular stability and hence provides excellent clinical and radiological outcome.