Evaluation of the clinical, functional and radiological outcomes in patients with distal tibia fractures with simple intra-articular extension treated with intramedullary multidirectional locking nail: a prospective study


  • Sanket Bajaj Department of Orthopaedics, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Mumbai, Maharashtra, India
  • Raunak Dhawale Department of Orthopaedics, Government Medical College and Hospital, Nagpur, Maharashtra, India
  • Rohit N. Garg Department of Orthopaedics, Bharatratna Doctor Babasaheb Ambedkar Municipal Hospital, Kandivali, Mumbai, Maharashtra, India




Intramedullary multidirectional locking nail, Syndesmotic injury, Johner and Wruh’s criteria, Valgus


Background: Distal tibia fractures with extension into the ankle joint (AO/OTA type 43C) poses challenge for an orthopedic surgeon, due to its subcutaneous nature and precarious blood supply. Literature has described various treatment modalities; most commonly used being locking compression pates, external fixators and intramedullary multidirectional locking nails.

Methods: This prospective study included 60 patients with distal tibia fracture AO type 43C1 and 43C2, managed with intramedullary multidirectional locking nails in a close manner, with intra-articular fragment fixation preceding the nail insertion. The aim of this study was to evaluate the clinical, functional and radiological outcomes as well as the complications in these patients.

Results: Patients’ mean age was 48.7±16.6 years; most had type 43C1 fractures (51 patients). The mean surgery time was 88.4±17.5 minutes, performed within 5.6±2.01 days post-injury. The 30 patients had fibula fracture with syndesmotic injury which was fixed with TENS nail. The functional assessment with Johner and Wruh’s criteria; 45 patients (75%) had excellent, 12 patients (20%) had good and 3 patients (5%) had fair outcomes. The fracture union averaged 16.7±1.63 weeks (14-20 weeks). 6 patients had superficial wound complication, while 3 patients had valgus malalignment; all managed without further surgery.

Conclusions: Intramedullary nailing following specific surgical technique, and potential percutaneous screws; is a safe, effective and successful treatment option for AO/OTA types 43C1 and 43C2 fractures with high fracture union rates, high functional results, and low complication rates.


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Original Research Articles