Distal tibial fractures fixation using retrograde tibial intramedullary nail in high-risk patients: a retrospective study.

Distal tibial fractures are common lower-limb injuries and are generally associated with a high risk of postoperative complications, especially in patients with multiple medical comorbidities. This study sought to ascertain the efficacy of retrograde intramedullary tibial nails (RTN) for treating extra-articular distal tibial fractures in high-risk patients. Between January 2019 and December 2021, 13 patients considered at high risk for postoperative complications underwent RTN fixation. Comorbidities in the patient sample included diabetes, renal disease, hypertension, severe osteoporosis, hemorrhagic blisters, long-term smoking, alcoholism and so on. Medical records were retrospectively reviewed to assess treatment data, wound complications, infections, hardware failure, time to bone union, and functional outcomes. The mean preoperative waiting time and operation duration was 7.1 ± 1.7 days and 61.1 ± 7.1 minutes, respectively. The hospital stay time ranged from 10 to 16 days, with a mean of 12.6 ± 1.9 days. All patients were monitored for a mean follow-up time of 17.5 ± 3.3 months. All patients achieved fracture union with an average healing time of 5.0 ± 0.7 months. No implant failure or persistent pain was observed in the surgical site. Two patients had superficial infection, but no further complications resulted from the incision. At the final follow-up, the average AOFAS score was 84.0 ± 7.3 points, with an excellent and good rate of 76.9%. RTN appears to be a reliable treatment option for extra-articular distal tibial fractures in high-risk patients.