Extreme Nailing: Is It Safe to Allow Immediate Weightbearing after Intramedullary Nail Fixation of Extraarticular Distal Tibial Fractures (OTA 43-A)?

Abstract

OBJECTIVES\nTo determine if immediate weightbearing after intramedullary (IM) fixation of extraarticular distal tibial fractures (OTA 43-A) results in a change in alignment prior to healing.\n\n\nDESIGN\nRetrospective review.\n\n\nSETTING\nLevel 1 trauma center.\n\n\nINTERVENTION\nIntramedullary nailing of distal tibial fractures.\n\n\nPATIENTS/PARTICIPANTS\nFifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA 43-A1, 20 OTA 43-A2, and 16 OTA 43-A3; 20 fractures were open.\n\n\nMAIN OUTCOME MEASUREMENTS\nChange in fracture alignment or loss of position.\n\n\nRESULTS\nAverage change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment and two fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap coverage and 4 required staged grafting because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement without implant revision, and 2 for aseptic nonunion). No patient had revision for implant failure.\n\n\nCONCLUSIONS\nImmediate weightbearing after IM fixation of extraarticular distal tibial fractures (OTA 43-A) led to minimal change in alignment and appears to be safe for most patients. Complications were consistent with those reported in previous non-weightbearing cohorts.\n\n\nLEVEL OF EVIDENCE\nLevel IV, case series.