Interlocking Intramedullary Nailing in the Distal Metaphyseal Fractures of the Tibia

PURPOSE: To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS: Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS: Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION: Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.

Treatment of Distal Tibial Metaphyseal Fracture Using MIPPO Technique / 대한족부족관절학회지

PURPOSE: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. MATERIALS AND METHODS: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. RESULTS: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks (2~4 weeks) and full weight bearing ambulation at average 5.2 weeks (4~8 weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks (8~18 weeks) postoperatively. Two cases showed 5 degrees limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had 6 degrees valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. CONCLUSION: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.