To review the efficiency of the primary closed IM nail in 15 cases of distal tibial metaphyseal fractures.

From January 1997 to August 1998, 15 patients were treated by closed intramedullary nailing for distal metaphyseal tibial fracture. All operations were done on the fracture table in supine position, and any fracture extending into the ankle joint was stabilized by supplementary cannulated screw.

According to Robinson classification, there were 5 type I fractures (33%) , 6 type IIa fractures (40%) , 2 type IIb fractures (13%) , and 1 type IIc fracture (7%) . The mean distance between the distal end of fracture and tibial plafond was 2.3cm (range 0 to 4.5cm) . Three intraarticular fractures were stabilized by a supplementary cannulated screw. The mean score was 93.7 point ( excellent 7 cases, good 4 cases, fair 4 cases ) by Baird ankle scoring system There were no poor results. Fourteen patients (93%) went on to union at average of 18weeks (range 12-28weeks) . One type IIIa open fracture failed to unite and one patient had a valgus deformity of 7 degrees. Nonunion was succesfully treated by bone graft. There was no soft tissue necrosis or infection.

In this study, we confirmed that IM nailing is one of the safe and effective methods for treating distal tibial metaphyseal fractures.