Intramedullary nailing and angulation prevention in distal metaphyseal tibial fractures

Intramedullary nailing, which is preferred in tibial diaphyseal fractures, is also frequently used in distal third tibial fractures. Various angular deformities, including varus/valgus deformity, may be observed during postintramedullary nailing. Orthopedic surgeons use several methods to prevent this problem.In this study, at least 2 static locking screws were placed proximal and distal to the nail during intramedullary nailing of distal third tibial fractures. No additional supportive methods were used. The efficacy of this technique in the prevention of postoperative angular deformities was retrospectively investigated. Thirty-four patients with distal third tibial fractures who were treated with intramedullary nailing were included in the study. Angulations were measured in the anteroposterior and lateral planes on plain radiographs obtained preoperatively, on postoperative day 1, and after fracture union. Angulations measured on postoperative day 1 were compared with those measured after fracture union, and an increase was observed. Based on statistical analyses, the increase in the angulations was not significant.In distal third tibial fractures, when fixation was performed by placing 2 static screws distal and proximal to the intramedullary nail following adequate reduction, the angulations that developed during the period until union were not significant in terms of causing deformity, although additional fixation methods are not used.