Outcomes of extra-articular proximal and distal third tibial fractures in adults treated using multidirectional tibial nail

Introduction: Although intramedullary nailing is the treatment of choice for the management of tibial diaphyseal fractures, they are infrequently used in the very proximal and distal third fractures due to their technical limitations. Hence, the conventional nail has been modified to Multidirectional Tibia Nail, which improves the stability of the fixation and reduces secondary malalignment. We aimed to assess the functional outcomes of extra-articular proximal and distal third tibia fractures treated with multidirectional tibia nailing in terms union outcomes and associated complications. Materials and Methods: In this study, we assessed the time of union, functional outcomes, radiological outcomes, and associated complications, in 30 patients with extra-articular tibial fractures who were treated using Multidirectional Tibia Nail. Results: The mean time of union of fracture was 20.97±4.01weeks. The radiological union evaluated using the RUST (Radiographic Union Scale in Tibia fractures) had a mean score of 10.77±1.19. The functional outcomes measured using Johner-Wruhs criteria showed 23 excellent, five good, and two fair outcomes. Majority of the patients regained full range of movements of both the knee and ankle joints. The mean duration of the union was higher among open type, distal third, and AO type C fractures. We noted two (6.7%) cases of superficial infections, five delayed unions (17%), and two patients with shortening (6.7%). Four patients (12.1%) required dynamization. Radiologically, 4 cases (13.4%) had primary malalignment, and two (6.7%) had secondary malalignment. Conclusion: We could extend the indications of intramedullary nailing to treat high or low-lying fractures using Multidirectional Tibia Nail. It provides stable internal fixation and has a lower rate of complications.