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Extreme Nailing

Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?

Beebe, Michael J. MD*; Morwood, Michael MD; Serrano, Rafael MD; Quade, Jonathan H. MD§; Auston, Darryl A. MD; Watson, David T. MD; Sanders, Roy W. MD; Mir, Hassan R. MD

doi: 10.1097/BOT.0000000000001484
Original Article
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Objectives: To determine whether immediate weightbearing after intramedullary (IM) fixation of extra-articular distal tibial fractures (OTA/AO 43-A) results in a change in alignment before healing.

Design: Retrospective review.

Setting: Level 1 trauma center.

Intervention: IM nailing of distal tibial fractures.

Patients/Participants: Fifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 43-A1, 20 OTA/AO 43-A2, and 16 OTA/AO 43-A3; 20 fractures were open.

Main Outcome Measurements: Change in fracture alignment or loss of position.

Results: Average change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment; and 2 fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap coverage and 4 required staged grafting because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement without implant revision, and 2 for aseptic nonunion). No patient had revision for implant failure.

Conclusions: Immediate weightbearing after IM fixation of extra-articular distal tibial fractures (OTA/AO 43-A) led to minimal change in alignment and seems to be safe for most patients. Complications were consistent with those reported in previous non-weightbearing cohorts.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN;

Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;

Department of Orthopaedic Surgery, University of South Florida, Tampa, FL;

§Division of Orthopedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and

OrthoONE, North Suburban Medical Center, Thornton, CO.

Reprints: Michael J. Beebe, MD, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104 (e-mail: mbeebe@uthsc.edu).

Presented at the Annual Meeting of the Orthopaedic Trauma Association, October 5–8, 2016, National Harbor, MD.

M. J. Beebe serves as an editor for Orthopaedic Clinics of North America and is a paid consultant for Smith and Nephew. J. H. Quade is a paid consultant for Smith and Nephew. D. T. Watson is a paid consultant for Corin and Smith and Nephew. R. W. Sanders serves on the board for the Journal of Orthopaedic Trauma, Orthopaedic Trauma Association, and Orthopaedics Today, is a paid consultant for Biomet, Smith and Nephew, Stryker, and Zimmer, receives research support from Health and Human Services, Medtronic, National Institutes of Health, Smith and Nephew, Stryker, METRC (DOD), and OTA, and receives royalties from CONMED Linvatec and Smith and Nephew. H. R. Mir serves on committees for the American Academy of Orthopaedic Surgeons, Journal of Orthopaedic Trauma, Orthopaedic Trauma Association, and the Foundation for Orthopaedic Trauma, owns stock in Core Orthopaedics, and is a paid consultant for Smith and Nephew and Synthes. The remaining authors report no conflict of interest.

Accepted March 14, 2019

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