Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia.

Treatment of peritrochanteric fractures involves reduction and synthesis using reconstruction plates and screws, intramedullary or cephalomedullary nails, or external fixators. A new cephalomedullary nail, Endovis BA (Citieffe, Italy), made of titanium alloy implanted without reaming and is fixed with 2 cephalic screws was used to treat 1091 patients with lateral fractures of the femoral neck (AO class 31-A). The patients had a mean age of 75 years (range, 48-99 years), and 83% had one or more systemic comorbidities. Mean operative time was 35 min (range, 20-100 min), and 483 patients (44.3%) required transfusion of one or more units of blood. The nail was implanted without distal blockage in 886 patients (81.2%) and without reaming in 1081 patients (99.1%). Intra-operative complications were recorded in 28 patients (2.6%). At the 6-month follow-up, 128 patients (12%) had died from causes unrelated to the surgery. Of the remaining 963 patients, 632 (65.6%) could walk independently, 249 (25.9%) could walk with assistance, and 82 (8.5%) could not walk. Postoperative complications were recorded in 38 patients (3.5%); most common complications were cut-out (10 cases), loss of reduction (8 cases) and prominent screws (6 cases). In conclusion the Endovis BA nail seems to be a reliable choice for the treatment of lateral fractures of the femoral neck, especially considering the short operating time and low rate of complications.

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