Evaluation of nail-plate construct fixation for complicated distal tibial fractures: a retrospective analysis of clinical and radiographic outcomes

Distal tibial fractures are complex injuries and present significant management challenges owing to their proximity to the ankle joint, poor vascular supply, and extensive soft tissue damage. The nail-plate construct (NPC) has been proven to be a solid fixation method for multiple types of complicated open or closed fractures. However, the use of the NPC in patients with complicated distal tibial fractures has not been comprehensively reported. This case series involved eight patients who underwent NPC for distal tibial fractures. We assessed the postoperative radiographic union status and functional outcomes of patients using the Olerud–Molander Ankle Score (OMAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score. A web-based questionnaire featuring the presentation of three cases treated with NPC was distributed to orthopedic trauma surgeons to gauge their perceptions of NPC following a review of the study results. At the 12-month follow-up, the average OMAS and AOFAS scores were 77.63 and 82, and the average time to radiographic union and weight bearing was 7.8 and 3.4 months, respectively. Following the questionnaire, 95% of the surveyed surgeons indicated a willingness to consider NPC as a definite fixation method for future cases of complicated distal tibial fractures, demonstrating increased acceptance of this technique. The NPC technique has good functional and radiographic outcomes for complicated distal tibial fractures and has promising potential for broader clinical acceptance. We advocate for the application of the NPC technique in specific cases, such as combined Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association 42 and 43 tibial fractures, distal tibial fracture nonunion, and open fractures with bone defects.