The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Functional Outcome of Management by Intramedullary Interlocking Nailing for Extra-Articular Distal Tibial Fractures in Adults

Document Type : RESEARCH PAPER

Authors
Sathish Kumar Dake 1
Rajashekhar Tati 1
Polisetty Venkata Shyam Prasad 1
Paidi Srivenkat Saketh 1
Anga Venkata Suresh 2
1 GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Visakhapatnam, Andhra Pradesh, India
2 Community Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology,Visakhapatnam, Andhra Pradesh, India
10.22038/abjs.2025.88106.3991
Abstract
Objectives: Extra-articular distal tibial fractures (EADTFs) are commonly associated with fibular fractures in approximately 85% of cases and present unique challenges due to their unstable nature and propensity for complications such as malunion, delayed union, non-union, and soft tissue compromise. This study aimed to evaluate the functional and radiological outcomes of intramedullary interlocking nailing (IMN) in the management of EADTFs.
Methods: This prospective observational study was conducted on 30 patients diagnosed with extra-articular distal tibial fractures, who underwent intramedullary nailing at a tertiary care center. Radiographic assessments included time to union, loss of reduction, and angular malalignment. Diagnostic criteria for consistent bony union, non-union, delayed union, and malunion were applied. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system during follow-up evaluations.
Results: Of the 30 patients included, the mean age was 41.6 ± 15.6 years, with a male predominance (73.3%). Based on the AOFAS score, 26.7% of patients achieved an excellent outcome, 56.7% had good outcomes, and 16.6% had fair outcomes. No patient recorded a poor outcome. Radiologically, the mean time to union was 18.5 ± 2.2 weeks. Malunion occurred in 6.7% of cases, while there were no instances of delayed union, non-union, or infection reported.
Conclusion: Intramedullary interlocking nailing is a reliable and effective treatment modality for extra-articular distal tibial fractures, offering favorable functional outcomes and a low complication rate. The technique demonstrates consistent union rates and minimal risk of infection or non-union, reinforcing its role as a preferred management strategy in appropriately selected cases.
        Level of evidence: IV
Keywords
AOFAS score
Extra-articular distal tibial fractures
Functional outcome
Intramedullary nailing
Malunion
Subjects
  1. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem? Acta Orthop Scand. 1998;69(1):43-47. doi:10.3109/17453679809002355.
  2. Koval KJ, Lurie J, Zhou W, et al. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma. 2005;19(9):635-639. doi: 10.1097/01.bot.0000177105. 53708.a9.
  3. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone. 2002;31(3):430-433. doi:10.1016/s8756-3282(02)00832-3.
  4. Canale ST, Beaty JH. Campbell Operative Orthopedics. 12th ed. Maryland Heights, Missouri: Mosby; 2013.
  5. Whittle AP, Russell TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am. 1992;74(8):1162-1171.
  6. Hutson JJ, Zych GA, Cole JD, et al. Mechanical failures of intramedullary tibial nails applied without reaming. Clin Orthop Relat Res. 1995;(315):129-137.
  7. Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006;20(1):76-79. doi: 10.1097/01.bot.0000202997. 45274.a1.
  8. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury. 2011;42(10):975-984. doi: 10.1016/j.injury.2010.02.019.
  9. Gupta A, Anjum R, Singh N, Hackla S. Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia. Arch Bone Jt Surg. 2015;3(2):119-123.
  10. Krettek C, Schandelmaier P, Tscherne H. Nonreamed interlocking nailing of closed tibial fractures with severe soft tissue injury. Clin Orthop Relat Res. 1995;(315):34-47.
  11. Angliss RD, Tran TA, Edwards ER, Doig SG. Unreamed nailing of tibial shaft fractures in multiply injured patients. Injury. 1996;27(4):255-260. doi:10.1016/0020-1383(96)00059-9.
  12. Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. J Am Acad Orthop Surg. 2006;14(7):406-416. doi:10.5435/00124635-200607000-00003.
  13. Hardy JRW, Richardson JB. Diaphyseal fractures of the tibia: defining the place of external fixation. In: De Bastiani G, Apley AG, Goldberg A, eds. Orthofix External Fixation in Trauma and Orthopaedics. London: Springer; 2000:275–285.
  14. Beshr M, Dixon J, Stevenson I. Distal Fibula Pro-Tibial Screws in Salvage Fixation of Bimalleolar Ankle Fractures in Osteoporotic Bone–A Novel Technique. Arch Bone Jt Surg. 2024;12(5):361-364. doi: 10.22038/ABJS.2024.76119.3515.
  15. Ahmed A, Ali M, Farooq MO, Sulaiman MA, Rashid H, Ahmad T. Benefits of Poller Screw in Improving Radiological Outcomes after Intra-Medullary Nailing for Distal Tibia Fractures; A Retrospective Cohort Study. Arch Bone Jt Surg. 2024;12(10):701-705. doi: 10.22038/ABJS.2024.79504.3639.
  16. Mahajan NP, Pawar ED, Supe AC, Managukiya HJ. Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases. International Journal of Research in Orthopedics. 2018 Jan; 4:65-71.
  17. Bajaj S, Dhawale R, Garg RN. 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. Int. J. Res. Orthop. s. 2024;10:138-47.
  18. Adhikari V, Sitaula P, Thapa O, et al. Functional Outcome of Solid Interlocking Nail in Open Tibial Fracture at a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2024;62(273):297-300.doi:10.31729/jnma.8571.
  19. Sagar B V S, Nandi SS, Kulkarni SR, Bagewadi R. Functional Outcomes of Tibia Fractures Treated With Intramedullary Interlocking Nails by Suprapatellar Approach: A Prospective Study. Cureus. 2023;15(6):e40485. doi:10.7759/cureus.40485.
  20. Patil R, Gowaikar A, Shirke A, Lokapur A, Ghelani G, Mehta S. A comparative study of extra-articular distal tibia fractures managed b y intramedullary nailing vs locking plate. Int J Orthop Sci. 2020;6:224-8.

 

  1. Sagar B V S, Nandi SS, Kulkarni SR, Bagewadi R. Functional Outcomes of Tibia Fractures Treated With Intramedullary Interlocking Nails by Suprapatellar Approach: A Prospective Study. Cureus. 2023;15(6):e40485. doi:10.7759/cureus.40485.
  2. Rahul PA, Mahesh V, Nagaraja BN, Narayanaswamy HD, Ranganath L, Srinivasamurthy KM. Studies on elastic stable intramedullary nailing (ESIN) for the treatment of diaphyseal fracture of femur in skeletally immature dogs using titanium elastic nails. Indian Journal of Veterinary Surgery. 2022;43(1):24-7.
  3. Arora KK, Kapila R, Chaudhary P, Singla R, Sanan L. Functional and radiological outcome of distal tibia fractures managed with expert tibia nail: a prospective clinical study. International Surgery Journal. 2023;10(8):1366.
  4. Kruppa CG, Hoffmann MF, Sietsema DL, Mulder MB, Jones CB. Outcomes After Intramedullary Nailing of Distal Tibial Fractures. J Orthop Trauma. 2015;29(9):e309-e315. doi:10.1097/BOT.0000000000000323.
  5. Otoukesh B, Parvandi A, Niroomand M, Karimpour M, Rahmanizadeh M, Amiri S. Managing Distal Tibia Fracture Nonunion by Using Custom-Made Three-Dimensional Titanium Cage; A Rare Case Report. Arch Bone Jt Surg. 2025.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 2
February 2026
Pages 129-134

  • Receive Date 09 June 2025
  • Revise Date 06 September 2025
  • Accept Date 07 September 2025