Extreme nailing and immediate weight bearing constructs in fractures of the distal tibia

Abstract

Extraarticular fractures of the distal tibia can present as difficult but manageable lower extremity injuries. Historically, these injuries have been fixed in a myriad of ways. Early management with intramedullary nailing had higher complication rates due to the unique anatomical and biomechanical features of the distal tibia. Modern improvements in intramedullary nailing surgical techniques and implant design have significantly decreased complication rates and led to improvement in patient outcomes. Many surgeons protect weight bearing postoperatively, but recent literature suggests that patients may safely weight bear immediately following intramedullary fixation. This article reviews technique and implant design changes that have facilitated immediate safe weight bearing following intramedullary nailing of extraarticular distal tibia fractures.

Comparison of Intramedullary Interlocking Nailing (IMLNG) and Minimally Invasive Plate Osteosynthesis (MIPO) in Treating Extra Articular Distal Tibial Fractures

“…However, due to the distal tibia's unique anatomy and the swelling and blistering that often accompany severe trauma, soft tissue problems such as wound dehiscence, superficial infection, exposed implants and delayed healing, are common following plating. 6 For tibia shaft fractures, intramedullary nailing is the gold standard since it is less intrusive and more biological than other options for fixing. Indications are expanded to encompass distal tibial fractures with partial articular extension, and it has recently acquired appeal for the management of extra articular pilon fractures.…”