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Low rate of malalignment using the tibial traction triangle for infrapatellar nailing of distal tibia fractures

Published:February 08, 2022DOI:https://doi.org/10.1016/j.injury.2022.02.014

      Highlights

      • We used a tibial traction triangle to treat distal tibia fractures with infrapatellar intramedullary nailing to determine rate of malalignment greater than 5°.
      • Of the 81 patients in the study, primary malalignment occurred in 4.9%, all in the coronal plane, with mean coronal alignment of 1.72° valgus.
      • Use of this device leads to a very low rate of primary malalignment with infrapatellar nailing, even in extremely distal fractures.

      Abstract

      Objectives

      To report on the immediate postoperative alignment of distal tibia fractures (within 10 cm of the tibial plafond) treated with infrapatellar intramedullary nailing (IMN) using the tibial traction triangle (TTT).

      Methods

      We performed a retrospective cohort study at a Level-I academic trauma center, with eighty-one skeletally mature patients with closed distal tibia fractures treated over a 10-year period with closed infrapatellar intramedullary nailing, without fibula fixation, using the TTT. The primary outcome measure is primary malalignment ≥5°.

      Results

      Primary malalignment occurred in 4 (4.9%) patients, all in the coronal plane. Mean coronal plane alignment was 1.72° valgus (range 3° varus to 8° valgus). No sagittal malalignment occurred. The fibula was intact in 5 (6.2%) cases. No patients underwent fibula fixation or blocking screw placement. Intra-articular extension occurred in 28 (34.6%) cases. Mean fracture distance from the plafond was 5.98 cm. Thirty-one patients had a fracture within 5 cm of the plafond, where malalignment was noted in 2 (6.5%) patients.

      Conclusions

      This is the first analysis of a large cohort of patients with distal tibia fractures treated with the TTT. Use of this device leads to a very low rate of primary malalignment with infrapatellar nailing, even in extremely distal fractures. We recommend consideration of this device as one more adjunct to help treat these difficult fractures successfully.

      Keywords

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