Retrograde tibial intramedullary nailing for distal tibial fractures: outcomes and complications

Retrograde tibial nailing (RTN) is a relatively new, minimally invasive technique for managing distal tibial fractures. Studies have demonstrated that RTN provides superior biomechanical stability compared to locking plates and yields favorable clinical outcomes. However, clinical data on RTN remain limited, particularly regarding its complication profile. This study aimed to evaluate the clinical efficacy of RTN in distal tibial fracture treatment, with a focus on identifying and analyzing associated complications.

A retrospective review was conducted on patients who underwent RTN for distal tibial fractures between August 2020 and December 2023 at a Level I trauma center. Collected variables included patient demographics, injury mechanism, fracture classification, operative time, length of hospital stays, time to radiographic union, time to full weight-bearing, American Orthopaedic Foot and Ankle Society (AOFAS) scores at final follow-up, and postoperative complications.

A total of 47 patients were included, with a follow-up duration ranging from 12 to 25 months (mean 17.0 ± 3.1 months). Radiographic union was achieved in 4 to 6 months (mean 4.5 ± 1.2 months). Full weight-bearing was resumed between 45 and 78 days postoperatively (mean 56.4 ± 11.2 days). Final AOFAS scores ranged from 73 to 95, with an average of 82.3 ± 9.2. Six complications were recorded: one case each of locking screw misplacement, posterior tibial tendon injury with associated ankle pain and swelling, medial ankle pain, loss of reduction, medial malleolus fracture, and superficial wound infection. No instances of implant failure, delayed union, nonunion, or deformity were observed.

RTN is an effective and reliable option for the treatment of distal tibial fractures, demonstrating favorable clinical outcomes and a low complication rate. Refinement of surgical techniques may further reduce the risk of complications.