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Updated: Apr 16, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Outcomes After Intramedullary Nailing of Distal Tibial Fractures
Christiane G Kruppa1, Martin F Hoffmann, Debra L Sietsema
1*Grand Rapids Medical Education Partners, Grand Rapids, MI; †Department of Surgery, BG University Hospital Bergmannsheil, Bochum, Germany; ‡College of Human Medicine, Michigan State University, Grand Rapids, MI; §Orthopaedic Associates of Michigan, Grand Rapids, MI; and ‖School of Medicine, Wayne State University, Detroit, MI.
Objectives:
To determine outcomes in the treatment of distal tibial fractures treated with intramedullary nails.
Design:
Retrospective analysis.
Setting:
Level I trauma center with follow-up in a private orthopaedic practice.
Main Outcome Measurements:
Radiographic determination of alignment, nonunion, and malunion, clinical outcome (range of motion, and implant-associated complaints), wound complications, and fibular fixation.
Patients:
A total of 105 patients with OTA/AO type A and C tibial fractures (<11 cm from the joint line) treated with intramedullary nailing.
Results:
Distance of the fracture from the joint line averaged 6.1 cm (range, 0-11). Mean follow-up was 25.6 months (range, 12-74). Nonunion occurred in 20 (19%) fractures and were significantly associated with open fractures (P = 0.012), wound complications (P < 0.001), and the need for fibular fixation (P = 0.007). Sagittal plane alignment averaged 2.5 degrees (±4.4) valgus. Malunion occurred in 25 (23.8%) fractures and again were significantly associated with open fractures (P = 0.045). Fifty (47.6%) patients had implant-related pain, which resolved in 27 (54.0%) after removal.
Conclusions:
Intramedullary nailing of distal tibial fractures is a suitable treatment option. Acceptable alignment and range of motion can be achieved. Both nonunions and malunions were significantly associated with open fractures, wound complications, and fibular fixation. Implant removal was needed in 25% of cases.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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