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Does the distal nail position impact the rates of misalignment and bone union in distal tibial fractures?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

This retrospective study aimed to assess the impact of distal nail placement on misalignment and healing rates in distal tibial fractures.

Methods

We reviewed all patients with distal tibial fracture treated with intramedullary nailing between 2015 and 2021, and a minimum follow-up of 12 months. Distal nail positioning was determined according to the Triantafillou zones. We related these positioning zones to misalignments (alignment ≥ 3°) and too bony union disorders (delayed union, non-union).

Results

Out of the 62 patients included, 56 (90.3%) show bone union without additional procedure, 3 (4.8%) with dynamization, and 3 (4.8%) showed non-union. Twenty-one (33.8%) presented misalignment, with valgus in the coronal plane being the most frequent (76.19%). In patients with and without misalignment, the most frequent distal nail position was 2–2 in 47.6% and 80.5%, respectively (p = 0.01). In multivariate analysis, distal nail positioning in the 2–2 zone showed a significant protective effect against misalignment (OR 0.18; p = 0.018), while nail positioning in the 3–2 zone generated a significant risk of misalignment (OR 18.55; p = 0.009).

Conclusion

In intramedullary nailing of distal tibial fractures, distal positioning of the nail slightly lateral to the center of the talus in the coronal plane and slightly posterior in the sagittal plane (zone 2–2) allows high alignment percentages to be obtained. Positioning medial to this point in the coronal plane (zone 3) is associated with more significant misalignment and should be avoided.

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Availability of data and material

All data generated and analyzed during this study are included in this published article and are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina

    Germán Garabano, Adrian Jaime, Leonel Perez Alamino, Juan Pablo Taleb, Joaquin Rodriguez & Cesar Angel Pesciallo

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  1. Germán Garabano
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  2. Adrian Jaime
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  3. Leonel Perez Alamino
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  4. Juan Pablo Taleb
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  5. Joaquin Rodriguez
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  6. Cesar Angel Pesciallo
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Contributions

All authors contributed to the study´s conception and design. Material preparation, data collection, and analysis were performed by German Garabano, Adrian Jaime, and Leonel Perez Alamino. The first draft of the manuscript was written by German Garabano and Adrian Jaime. All authors read and approved the final manuscript.

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Correspondence to Germán Garabano.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the British Hospital and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. (Project Number 9429).

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Informed consent was obtained from all individual participants included in the study.

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Garabano, G., Jaime, A., Alamino, L.P. et al. Does the distal nail position impact the rates of misalignment and bone union in distal tibial fractures?. Eur J Orthop Surg Traumatol 33, 3365–3371 (2023). https://doi.org/10.1007/s00590-023-03566-2

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  • DOI: https://doi.org/10.1007/s00590-023-03566-2

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