Intramedullary Nailing as an Effective Alternative to Plating for Far Distal Third Tibial Fractures: Extreme Nailing

Introduction The management of far 1/3 ^rd distal tibial metaphyseal fractures presents challenges due to high-energy trauma and extensive soft tissue damage. Traditional treatments like open plating are associated with complications. "Extreme nailing," an alternative approach using intramedullary (IM) nailing at the far ends of the tibia, excluding intra-articular areas offers advantages such as three-directional stability and minimal soft tissue disruption. This study aims to evaluate the efficacy of closed IM nailing in extreme distal tibial fractures for improved outcomes using newer designed nails with advanced features for tibial fixation. Material and methods This study is a 2-year prospective and retrospective cohort study of 30 patients designed to evaluate the functional and radiological outcomes of extreme nailing in the treatment of far distal tibial extra articular fractures. The functional outcome was measured by the AOFAS (American orthopaedic foot and ankle society) scoring system and SF-36 score. The study was done at a tertiary orthopaedic trauma centre with a follow up span of at least 12 months. Results The mean union time was 5 months, and out of 30 patients 5 patients were lost to follow up. As for the remaining 25 patients, 1 patient had non union and 1 had delayed union. 5 patients had implant tip pain within 1 year of surgery. At final follow up all 25 patients could walk full weight bearing without support and without affecting their day-to-day activities. Conclusion This study shows that advanced tibial nails offer stability, reduced tissue damage, and easier insertion, providing rigid internal fixation. This technique allows early mobilization and yields excellent functional and clinical outcomes for extreme tibial fractures with minimal morbidity. Level of evidence: 3