• Julia Greenfield, Philipp Appelmann, Felix Wunderlich, Dorothea Mehler, Pol Maria Rommens, and Sebastian Kuhn.
• Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
• Eur J Trauma Emerg Surg. 2022 Oct 1; 48 (5): 3693-3700.

ObjectivesRetrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology.MethodsSix Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations.ResultsThe removal of one distal screw resulted in a 60-70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading.ConclusionsThe DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.© 2021. The Author(s).

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