Tibio-talar antegrade nailing for distal tibial fractures. An innovative way to save lower limb in the context of very severe 43C fractures of the tibial pilon.

Objectives: 43C type fractures are rare but challenging situations. This work aimed to present the results of an innovative surgical technique for this type of trauma: antegrade tibio-talar nailing. Methods: This retrospective and monocentric study included patients operated in a level 1 trauma center between May 2013 and July 2022 for antegrade tibio-talar nail. This procedure was indicated for 43C type fractures of the tibial pilon. The usual treatment plan was a two steps procedure: the first step was conducted with external fixation and soft tissues management for the damage control. The second step was initiated after soft tissues full recovery and consisted in a tibio-talar nailing with bone graft if necessary. A usual tibial nail hardware was used to fix the skeleton. The main evaluation criteria were bone consolidation. Complications were collected and are exposed. Amputation or death were considered as a failure. Results Six patients were included and reached full bone consolidation. They could walk at final follow-up. Many infections were observed, and 2 patients had a chronic osteomyelitis with acceptable pain and organized continuous follow-up. Conclusions Antegrade tibio-talar nailing is a rare surgical indication, helping lower limb salvage in high energy traumatology. It is an acceptable surgical technique for very comminuted 43C type fractures, associated with soft tissue damages. More studies should be conducted to correctly evaluate the results in a larger scale. Level of evidence IV