Dia-metaphyseal fractures of the distal tibia treated with intramedullary nails distally locked with an innovative locking system: a retrospective clinical study

Abstract

Purpose In this study, we aimed to present our clinical and functional results of distal tibial dia-metaphyseal fractures treated with an intramedullary nail that locks distally with an innovative distal locking system called a distal supportive bolt locking screw (DSBLS). Methods Forty-eight patients with distal tibia dia-metaphyseal fractures operated with IMNs distally locked with DSLBS in a level I trauma center were included. Inclusion criteria were fractures of the distal tibia at one-third the distal segment level with simple articular involvement. Functional and radiological assessments were made after at least 14 s. Results were evaluated according to the Johner and Wruhs criteria. The quality of the initial alignment and during follow-ups, malunion, nonunion, and any other complications were evaluated. Technical problems during interventions and implant failures during follow-ups were assessed. Results All fractures achieved union. The average healing duration was a mean of 17.4 (8-24) weeks. Initial fixation in the recurvatum between 5 degrees and 10 degrees was detected in six patients. No loss during initial reduction was detected during the follow-up of any patient. According to the Johner and Wruhs criteria, 42 patients were functionally evaluated as excellent and six were evaluated as good. No loosening, migration, or breakage of the DSLBS were observed in any patient. Conclusion The DSBLS provided a stable anchor point for the nail even for very short metaphyseal fragments. It prevented rotation and angulation in both the coronal and sagittal planes without preventing compression, which is mandatory for early weight bearing and bone union.