Background: The treatment of distal metaphyseal tibial fractures
remains controversial. This study was performed to evaluate the results of
intramedullary nailing of distal tibial fractures located within 5 cm of the
Methods: Over a sixteen-month period at two institutions, thirty-six
tibial fractures that involved the distal 5 cm of the tibia were treated with
reamed intramedullary nailing with use of either two or three distal
interlocking screws. Ten fractures with articular extension were treated with
supplementary screw fixation prior to the intramedullary nailing. Radiographs
were reviewed to determine the immediate and final alignments and
fracture-healing. The Short Form-36 (SF-36) and Musculoskeletal Function
Assessment (MFA) questionnaires were used to evaluate functional outcome.
Results: Acceptable radiographic alignment, defined as <5° of
angulation in any plane, was obtained in thirty-three patients (92%). No
patient had any change in alignment between the immediate postoperative and
the final radiographic evaluation. Complications included one deep infection
and one iatrogenic fracture at the time of the intramedullary nailing. Six
patients could not be followed. The remaining thirty fractures united at an
average of 23.5 weeks. Three patients with associated traumatic bone loss
underwent a staged autograft procedure, and they had fracture-healing at an
average of 44.3 weeks. The functional outcome was determined at a minimum of
one year for nineteen patients and at a minimum of two years (average, 4.5
years) for fifteen patients. At one year, there were significant limitations
in several domains despite fracture union and maintenance of alignment, but
there was improvement in the MFA scores with time.
Conclusions: Intramedullary nailing is an effective alternative for
the treatment of distal metaphyseal tibial fractures. Simple articular
extension of the fracture is not a contraindication to intramedullary
fixation. Functional outcomes improve with time.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.