- See:
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IM nailing of tibia fractures - menu:
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tibial plafond fractures
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Distal Tibia Fracture:
- see:
external fixation for distal tibia fracture ,
outcomes of external fixation vs IM nailing, and
plate fixation;
- w/ frx extension into the joint, consider placement of percutaneous lag screws to repair intra-articular fracture lines before nailing is performed;
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guide wire:
- the guide wire needs to be directed towards the medial malleolus while the ankle is held in valgus;
- this will minimize the tendency for the fracture to drift into varus as the nail passes across the fracture site;
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transfibular blocking screw (as a temporary means of achieving reduction)
- using percutaneous technique, insert a screw across the fibula until it engages the tibia.
- additional passage of the transfibular screw will begin to translate the distal tibial fracture site in medial direction;
- a second screw (inserted below the first screw) may also be required inorder to optimize the reduction;
- once the nail has been inserted and once interlocking screws are in place, the transfibular screws can be removed;
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blocking screws:
- antero-posterior blocking screws are inserted on either side of the central nail insertion zone inorder to effect an anatomic reduction;
- in general, the blocking screw is positioned where you don't want the nail to go;
- with fracture demonstrating preoperative varus displacement, consider an antero-posterior blocking screw inserted on medial side of distal fragment;
- in general, the blocking screw should remain as peripheral as possible (minimal blockage) inorder to prevent iatrogenic comminution of the distal
fragment at the opposite end of the fracture;
- once blocking screws have been positioned, consider passing reamers across the fracture site, inorder to ensure safe nail passage;
-
ORIF of distal fibula:
- some authors recommend concomitant ORIF of the
distal fibula (if frx is present), inorder to improve rotational stability;
- references:
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Effect of Fibular Plate Fixation on Rotational Stability of Simulated Distal Tibial Fractures Treated with Intramedullary Nailing.
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Does Fibular Plating Improve Alignment After Intramedullary Nailing of Distal Metaphyseal Tibia Fractures?
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The effect of concurrent fibular fracture on the fixation of distal tibia frxs: a laboratory comparison of IM nails with locked plates.
- references:
Modified tibial nails for treating distal tibia fractures;
Interlocking intramedullary nailing in distal tibial fractures.
Dia-metaphyseal distal tibial fractures--treatment with a shortened intramedullary nail: a review of 15 cases.
The unreamed tibial nail in the treatment of distal metaphyseal fractures.
Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing.
Interlocking intramedullary nailing in distal tibial fractures.
Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement.
Nonunions of the Distal Tibia Treated by Reamed Intramedullary Nailing.
Intramedullary Nailing of Distal Metaphyseal Tibial Fractures.
Treatment of Distal Tibia Fractures Without Articular Involvement: A Systematic Review of 1125 Fractures.
Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing.
Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing.
