title: Outcomes After Intramedullary Nailing of Distal Tibial Fractures.
abstract: OBJECTIVE
  To determine outcomes in the treatment of distal tibial fractures treated with intramedullary nails.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Level I trauma center with follow-up in a private orthopaedic practice.
  
  
  METHODS
  Radiographic determination of alignment, nonunion, and malunion, clinical outcome (range of motion, and implant-associated complaints), wound complications, and fibular fixation.
  
  
  METHODS
  A total of 105 patients with OTA/AO type A and C tibial fractures (<11 cm from the joint line) treated with intramedullary nailing.
  
  
  RESULTS
  Distance of the fracture from the joint line averaged 6.1 cm (range, 0-11). Mean follow-up was 25.6 months (range, 12-74). Nonunion occurred in 20 (19%) fractures and were significantly associated with open fractures (P = 0.012), wound complications (P < 0.001), and the need for fibular fixation (P = 0.007). Sagittal plane alignment averaged 2.5 degrees (±4.4) valgus. Malunion occurred in 25 (23.8%) fractures and again were significantly associated with open fractures (P = 0.045). Fifty (47.6%) patients had implant-related pain, which resolved in 27 (54.0%) after removal.
  
  
  CONCLUSIONS
  Intramedullary nailing of distal tibial fractures is a suitable treatment option. Acceptable alignment and range of motion can be achieved. Both nonunions and malunions were significantly associated with open fractures, wound complications, and fibular fixation. Implant removal was needed in 25% of cases.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Grand Rapids Medical Education Partners, Grand Rapids, MI; †Department of Surgery, BG University Hospital Bergmannsheil, Bochum, Germany; ‡College of Human Medicine, Michigan State University, Grand Rapids, MI; §Orthopaedic Associates of Michigan, Grand Rapids, MI; and ‖School of Medicine, Wayne State University, Detroit, MI.
authors.forename: Christiane G
authors.initials: CG
authors.lastname: Kruppa
authors.forename: Martin F
authors.initials: MF
authors.lastname: Hoffmann
authors.forename: Debra L
authors.initials: DL
authors.lastname: Sietsema
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Mulder
authors.forename: Clifford B
authors.initials: CB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000601:surgery*; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult