Combined Intramedullary Nailing and Interfragmentary Screws in Distal Tibial Fractures With Articular Extension

The treatment of distal tibial fractures with an articular fracture line remains controversial. Intramedullary nailing allows for the maintenance of good frontal and sagittal alignment, as well as rapid and satisfactory functional recovery. In this retrospective case series, we present our department's experience with 20 patients presenting with AO 43C1 and 43C2 fractures, treated with intramedullary nailing combined with interfragmentary screw fixation over an eight-year period, with a follow-up of 18 months. Postoperative alignment was assessed using radiographic measurements of the anterior distal tibial angle (ADTA) and lateral distal tibial angle (LDTA), immediately and at follow-up. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Descriptive statistical analysis was used to report means, standard deviations, and proportions. Acceptable alignment was achieved in 95% of patients. The AOFAS score exceeded 86% in 88% of patients, indicating excellent outcomes. Interfragmentary screw fixation prior to nailing improved construct stability, minimized malalignment risk, and enhanced functional recovery.