Improved Outcomes in Distal Tibial Non-Union: A Retrospective Study of 8 Patients Treated with Distal Tibial Nail and Screw Fixation

Alemdar C., Ulus S. A., Atiç R., Demir S., TOPAL İ., Sayar Ş.

Medical Science Monitor, vol.29, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 29
  • Publication Date: 2023
  • Doi Number: 10.12659/msm.942207
  • Journal Name: Medical Science Monitor
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE
  • Keywords: Fracture Fixation, Intramedullary, Pseudarthrosis, Tibia
  • Istanbul Medipol University Affiliated: Yes


Background: Non-union of distal tibia fractures is a challenge in orthopedic surgery and can be due to open fractures, osteopenia, infection, or failure of surgical devices. This retrospective study aimed to describe 8 patients with non-union of distal tibial fractures treated with distal tibial nail and screw fixation. Material/Methods: According to the Gustilo-Anderson classification, 3 patients had type 2 open fractures, 1 had a type 3 open fracture, 1 had a type 1 open fracture, and 3 had closed fractures. The Association of Osteosynthesis AO classified 4 patients as A2, 2 as B2, and 2 as C2. Seven patients received distal supporting bolt-locking-screw nails (DSBLS) and 1 received DSBLS nail and plate in their most recent operation. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud-Molander scores. Results: All 8 patients were male, with a mean age of 35.5±14.6 years. Six patients had atrophic non-union, 1 had hypertrophic non-union, and 1 had infected non-union. Union was achieved in all patients. The average union time was 25.1 (range, 12-60) months, and the follow-up duration was 3.6 (range, 2-6) years. The mean Olerud-Molander score was 92.5 (range 85-100), and the mean AOFAS score was 91.2 (range, 85-100). There was no evidence of rotational deformity or shortening. Conclusions: Distal tibial non-unions benefit from nails with DSBLS system due to their excellent biomechanical properties. These nails facilitate union and allow patients to bear weight early in the postoperative period, enabling a quicker return to normal activities.