Tibial pilon fractures treated by interlocking intramedullary nail with distal multi-directional locking

Objective To explore the clinical efficacy of pilon fracture treated by tibial multi-directional interlocking intramedullary nail. Methods From June 2010 to January 2013, data of 23 patients with pilon fracture who were treated by tibial multi-directional interlocking intramedullary nail were retrospectively analyzed. There were 15 males and 8 females, with an average age of 36.9 years (range, 32-61 years). They were all fresh fractures, including 22 cases of closed fractures and 1 case of opened fracture (Tscherne grade 1). According to the AO/OTA classification, there were 10 fractures of type C1, 8 fractures of type C2 and 5 fractures of type C3. According to the injury mechanisms, open reduction and internal fixation' was used. Non-restrictive screws were used to convert type "C" to type "A" after pry poking reposition, then intramedullary nail was used to fixate the fracture. Burwell-Charnley radiological evaluation system was used for radiological assessment, and Teeny-Wiss ankle clinical symptoms and functional score system was used for efficacy assessment postoperative. Results The mean followup period was 20.6± 2.3 months (range, 18-24 months). All fractures were healed at an average period of 16.8±4.0 weeks (range, 14-28 weeks). According to the Burwell-Charnley radiological evaluation system, 20 cases had obtained anatomic reduction, 2 cases fair reduction and only 1 case poor reduction. The anatomic reduction rate was 87.0% (20/23). At the latest followup, the mean Teeny-Wiss score was 91.6±9.5 (range, 60-100). There were excellent in 12 cases, good in 8 cases, fair in 2 cases, and poor in 1 case, and the overall excellent and good rate was 87.0%(20/23). None of the complications such as infection, breakage of screw loosening, malunion, nonunion occurred at the time of the latest followup, but 7 cases appeared tension blisters, one case appeared skin necrosis, and 6 cases got chronic pain in the knee postoperation. Conclusion Multi-directional interlocking intramedullary nail is a safe alternative for the treatment of pilon fractures with proper patient selection and surgical indication. Key words: Tibial fractures; Fracture fixation, internal; Bone screws