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 a 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 of 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.