title: Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures.
abstract: BACKGROUND
  Intramedullary nailing in distal tibial fracture is controversial because of a lack of stability. The present study sought to assess radiological and clinical results for a new "angular-stable" locking system in difficult indications for intramedullary nailing.
  
  
  METHODS
  A prospective study recruited 41 patients (41 tibias) with distal tibial fracture consecutively managed using angular-stable locked intramedullary nails. Radiologic assessment comprised AP and lateral lower-limb views, taken postoperatively and through to last follow-up. The mean distance was measured between fracture and joint line. Fusion, with or without malunion, primary reduction defect, non-union and secondary displacement were recorded, as were all complications.
  
  
  RESULTS
  Mean follow-up was 18 ± 5 months; 3 patients were lost to follow-up. Mean fracture distance from the joint line was 63 ± 25 mm. Fusion was achieved within 3 months in 29 cases (76%); delayed fusion in 7 patients (18%) required secondary dynamization at a mean 3 months, with favorable evolution. Revision surgery was required in 2 cases: 1 for secondary displacement exceeding 10°, and 1 for non-union at 7 months. Other complications mainly comprised 4 malunions of less than 10° due to primary reduction defect.
  
  
  CONCLUSIONS
  Angular-stable locked lower-limb intramedullary nailing provided a very satisfactory fusion rate, with few complications. It is, however, a demanding procedure, especially as regards fracture reduction and nail positioning in the distal fragment.
  level IV.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: Patrickboyer@free.fr.
authors.forename: P
authors.initials: P
authors.lastname: Boyer
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Charles
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Loriaut
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Alkhaili
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Mylle
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Pelissier
authors.affiliation: Service de chirurgie orthopédique et traumatologique, université Paris-Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Massin
mesh_terms: D000328:Adult; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Fracture; Leg; Locking; Nailing; Tibia