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

OBJECTIVES
To 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.


DESIGN
Retrospective review.


SETTING
Level 1 trauma center.


INTERVENTION
Intramedullary nailing of distal tibial fractures.


PATIENTS/PARTICIPANTS
Fifty-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.


MAIN OUTCOME MEASUREMENTS
Change in fracture alignment or loss of position.


RESULTS
Average 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.


CONCLUSIONS
Immediate 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.


LEVEL OF EVIDENCE
Level IV, case series.