Xu Weizhen, Lin Weibin, Chen Tianlai, Liu Hui, Zhang Jinhui, Wu Jin
Department of Orthopaedics, the 909th Hospital, School of Medicine, Xiamen University, Zhanghua Road 269, Zhangzhou, Fujian, 363000, China.
J Orthop Surg Res. 2025 Jun 12;20(1):584. doi: 10.1186/s13018-025-05995-7.
Retrograde tibial nailing (RTN) is a relatively new, minimally invasive technique for managing distal tibial fractures. Studies have demonstrated that RTN provides superior biomechanical stability compared to locking plates and yields favorable clinical outcomes. However, clinical data on RTN remain limited, particularly regarding its complication profile. This study aimed to evaluate the clinical efficacy of RTN in distal tibial fracture treatment, with a focus on identifying and analyzing associated complications.
A retrospective review was conducted on patients who underwent RTN for distal tibial fractures between August 2020 and December 2023 at a Level I trauma center. Collected variables included patient demographics, injury mechanism, fracture classification, operative time, length of hospital stays, time to radiographic union, time to full weight-bearing, American Orthopaedic Foot and Ankle Society (AOFAS) scores at final follow-up, and postoperative complications.
A total of 47 patients were included, with a follow-up duration ranging from 12 to 25 months (mean 17.0 ± 3.1 months). Radiographic union was achieved in 4 to 6 months (mean 4.5 ± 1.2 months). Full weight-bearing was resumed between 45 and 78 days postoperatively (mean 56.4 ± 11.2 days). Final AOFAS scores ranged from 73 to 95, with an average of 82.3 ± 9.2. Six complications were recorded: one case each of locking screw misplacement, posterior tibial tendon injury with associated ankle pain and swelling, medial ankle pain, loss of reduction, medial malleolus fracture, and superficial wound infection. No instances of implant failure, delayed union, nonunion, or deformity were observed.
RTN is an effective and reliable option for the treatment of distal tibial fractures, demonstrating favorable clinical outcomes and a low complication rate. Refinement of surgical techniques may further reduce the risk of complications.
逆行胫骨髓内钉固定术（RTN）是一种相对较新的、用于治疗胫骨远端骨折的微创技术。研究表明，与锁定钢板相比，RTN具有更好的生物力学稳定性，并能产生良好的临床效果。然而，关于RTN的临床数据仍然有限，特别是其并发症情况。本研究旨在评估RTN治疗胫骨远端骨折的临床疗效，重点是识别和分析相关并发症。
对2020年8月至2023年12月期间在一级创伤中心接受RTN治疗胫骨远端骨折的患者进行回顾性研究。收集的变量包括患者人口统计学资料、损伤机制、骨折分类、手术时间、住院时间、影像学愈合时间、完全负重时间、末次随访时的美国矫形足踝协会（AOFAS）评分以及术后并发症。
共纳入47例患者，随访时间为12至25个月（平均17.0±3.1个月）。影像学愈合时间为4至6个月（平均4.5±1.2个月）。术后45至78天恢复完全负重（平均56.4±11.2天）。末次随访时AOFAS评分范围为73至95分，平均为82.3±9.2分。记录到6例并发症：锁定螺钉位置错误1例、胫后肌腱损伤伴踝关节疼痛和肿胀1例、内踝疼痛1例、复位丢失1例、内踝骨折1例、浅表伤口感染1例。未观察到内固定失败、延迟愈合、不愈合或畸形的情况。
RTN是治疗胫骨远端骨折的一种有效且可靠的选择，具有良好的临床效果和较低的并发症发生率。手术技术的改进可能会进一步降低并发症的风险。
