Expert Tibia Nail: Is a Single Nail Enough to Fix Distal Tibia and Fibula Fractures?

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Biomechanical Fixation

Background:

• Management of extra-articular distal tibia fractures with supra-syndesmotic fibula fractures is debated, especially regarding fibular fixation necessity.
• The Expert Tibial Nail System (ETNS) offers multidirectional distal locking, potentially providing adequate stability without fibular fixation and reducing surgical morbidity.

Purpose of the Study:

• To compare clinical, radiological, intra-operative parameters, and complication rates between isolated ETNS fixation and conventional tibial intramedullary nailing with fibular plating.
• To evaluate the efficacy of ETNS in achieving stability and favorable outcomes for complex distal tibia and fibula fractures.

Main Methods:

• A hybrid prospective and retrospective comparative study included 120 patients (aged 18-60) with extra-articular distal tibia and associated supra-syndesmotic fibula fractures.
• Sixty patients received isolated ETNS fixation; sixty underwent conventional tibial nailing with fibular plating.
• Analysis included operative time, blood loss, radiation exposure, time to union, Olerud-Molander ankle score, deformity, and complications, using Student's t-test and chi-square test (p < 0.05 significance).

Main Results:

• The ETNS group showed significantly shorter operative time (32.9 vs. 63.86 min), lower blood loss (15.53 vs. 48.91 mL), and reduced radiation exposure (22.68 vs. 33.55 shots) (p < 0.05).
• Mean union time was significantly earlier in the ETNS group (18.1 vs. 22.5 weeks, p < 0.001), with superior functional outcomes (Olerud-Molander score: 96 vs. 90.66, p < 0.001).
• Overall complications were fewer with ETNS (23.33% vs. 43.33%), with higher rates of infection, ankle stiffness, and non-union in the fibular fixation group.

Conclusions:

• Isolated ETNS fixation provides superior clinical and radiological outcomes, earlier union, reduced operative morbidity, and fewer complications compared to conventional tibial nailing with fibular plating.
• Routine fibular fixation may be unnecessary for extra-articular distal tibia fractures with associated supra-syndesmotic fibula fractures when stable multidirectional tibial fixation is achieved with ETNS.