Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement

Objective: To evaluate the efficacy of intramedullary nailing in diaphyseal tibia fractures with distal intraarticular involvement. Design: Retrospective. Setting: Henry Ford Hospital, a level I trauma center. Patients/Participants: Twenty patients with twenty fractures at an average of twenty-two months of follow-up were evaluated. There were fifteen closed and five open fractures. Intervention: All fractures were stabilized with lag screw fixation (with or without supplemental plates) of the intraarticular-fracture extension or ankle fracture, and intramedullary nailing of the diaphyseal tibia fracture. Main Outcome Measurements: Time to bony union, malunion, knee and ankle range of motion, early arthrosis, and any complications of treatment were assessed. Results: Nineteen fractures healed, with an average time to bony union of seventeen weeks. One nonunion after grade IIIB open fracture required exchange nailing and healed after sixty-two weeks. Nineteen fractures had excellent alignment after healing. There were no infections. Conclusions: The indications for intramedullary nailing bf unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.