Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Kasr El-Aini Street, 11562, Cairo, Egypt,
Int Orthop. 2013 Oct;37(10):2009-15. doi: 10.1007/s00264-013-1998-y. Epub 2013 Jul 28.
Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or high-energy injuries. Its application in distal tibial fractures, however, remains controversial.
In this study, 101 distal tibial fractures treated using closed unreamed nailing were reviewed after a mean follow-up of 32 months. There were 59 type A und 42 type B fractures. The most common fracture pattern was the A1 spiral fracture (n = 40) followed by the B2 wedge fracture (n = 18). Intra-articular extension was encountered in 14 cases. One-fourth of the patients (n = 24) had open injuries. Forty-seven patients had additional injuries, and nearly one-third of them were polytraumatised.
Union occurred after a mean time of 23.9 (range, 11-134) weeks. There were 13 cases of delayed union and seven non-unions; all healed eventually with additional surgery in only six fractures. Malunion was seen in 12 cases (five valgus, two varus and five external torsion), ten of which were associated with unplated fibular fractures. Three fractures (two open) were treated for deep infection. The most common complication seen was fatigue failure of the locking screws (27 cases).
Unreamed nailing of distal tibial fractures is associated with a rather high rate of bone healing complications and locking screw failure. The decision for its use in the notoriously challenging fractures of this segment should be critically considered.
非扩髓髓内钉在治疗骨干长骨骨折中已被广泛接受，尤其是在多发创伤或高能损伤的情况下。然而，其在胫骨远端骨折中的应用仍存在争议。
本研究回顾了 101 例采用闭合式非扩髓髓内钉治疗的胫骨远端骨折患者，平均随访 32 个月。A型骨折 59 例，B 型骨折 42 例。最常见的骨折类型是 A1 螺旋骨折（n=40），其次是 B2 楔形骨折（n=18）。14 例骨折累及关节面。四分之一的患者（n=24）存在开放性损伤。47 例患者合并其他损伤，近三分之一为多发创伤。
平均愈合时间为 23.9 周（范围，11-134 周）。13 例出现延迟愈合，7 例出现不愈合；最终所有患者均愈合，仅 6 例骨折需要额外手术。12 例出现畸形愈合（5 例外踝畸形，2 例内翻畸形，5 例外旋畸形），其中 10 例与未固定的腓骨骨折有关。3 例（2 例开放性骨折）发生深部感染。最常见的并发症是锁定螺钉疲劳失效（27 例）。
胫骨远端骨折非扩髓髓内钉治疗后骨愈合并发症和锁定螺钉失效的发生率较高。在治疗该部位挑战性较大的骨折时，应慎重考虑是否使用该方法。
