Clinical and Functional Outcomes of Closed Intramedullary Interlocking Nailing in Extra-articular Distal Tibial Fractures: A Prospective Observational Study.

Abstract

Introduction: Extra-articular distal tibial fractures are difficult to manage because of poor soft-tissue coverage, limited vascularity, and the tendency for malalignment and delayed union. Closed intramedullary interlocking nailing has become an increasingly preferred treatment option because it preserves fracture hematoma and periosteal blood supply.

Aims: The aim of the study was to evaluate the clinical and functional outcomes of closed intramedullary interlocking nailing in extra-articular distal tibial fractures.

Materials and methods: This prospective observational, single-center study was conducted in the Department of Orthopaedics, People's College of Medical Sciences and Research Centre, Bhopal, between March 2024 and December 2025. Fifty consecutive patients aged 18-60 years with extra-articular distal one-third tibial fractures (closed or Gustilo-Anderson type I open fractures) were treated with closed intramedullary interlocking nailing. Functional assessment using the modified American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was performed preoperatively and at 2, 6, 9, and 12 weeks and 6 months. Radiographic union, alignment, progression of weight-bearing, and post-operative complications were assessed. Repeated AOFAS measurements were analyzed using the Friedman test.

Results: The mean age was 37.74 ± 12.26 years, and 80% of patients were male. Road traffic accidents accounted for 90% of injuries. AOFAS scores increased from 50.30 ± 1.99 preoperatively to 87.74 ± 7.85 at 6 months. Longitudinal analysis demonstrated a significant change in AOFAS scores across the six assessment points (Friedman χ2 = 239.80, df = 5, P < 0.001; Kendall's W = 0.959). At 6 months, 60% had excellent and 32% good AOFAS categories. Superficial infection occurred in 8%, delayed union in 4%, non-union in 4%, and malunion in 2%.

Conclusion: In this selected cohort of adults with extra-articular distal one-third tibial fractures, closed intramedullary interlocking nailing was associated with progressive short-term functional improvement and generally satisfactory fracture healing. Because the study was small, single-center, non-comparative, and limited to 6 months of follow-up, it does not establish superiority over plating, external fixation, or other treatment strategies, and longer comparative studies are required.