Rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures

Objective To explore how to make a rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures so as to avoid bad reduction of the distal rotation. Methods Twenty-one patients with complex tibial fracture underwent closed reduction and intramedullary nailing from January 2014 to January 2016. They were 16 males and 5 females, aged from 22 to 53 years (average, 34.6 years). By AO/OTA classification, 6 cases were type 42-C1, 2 type 42-C2, and 13 type 42-C3. During surgery, the relationship between the connecting rod of the front pressure lever of intramedullary nail in the tibia and the second metatarsal bone was used to judge the rotation. After surgery CT plane scanning was used to assess reliability of the intraoperative judgment of the rotation. Validity of the rotation judgment was finally evaluated by comparing Functional Index Questionnaire (FIQ) scores, Olerud Molander ankle scores (OMAS) and Health Status Questionnaire (SF-36) scores between pre-injury and final follow-up. Results The 21 patients were followed up for 12 to 24 months (average, 18.3 months). Bony union was achieved from 3 to 7 months after surgery (average, 4.5 months) without nonunion or refracture. There was no significant difference in the tangent angle between the proximal and distal tibiae on CT scan between the healthy side (47.1°±2.9°) and the affected side (44.8°±5.6°) (P >0.05). There were no significant differences either in FIQ scores, OMAS or SF-36 scores between pre-injury and final follow-up (P >0.05). Conclusion In the course of closed reduction and intramedullary nailing for complex tibial fractures, it is simple and effective to judge the distal inward or outward rotation by pointing the connecting rod of the front pressure lever of intramedullary nail in the tibia to the second metatarsal bone. Key words: Tibial farctures; Fracture fixation, intramedullary; Feasibility studies; Judgment