# Surgical treatment of distal tibia non-unions with a retrograde intramedullary nail as a therapy option to prevent amputation

## TL;DR

This study explores using a retrograde nail to treat non-healing tibia fractures, aiming to prevent amputation.

## Contribution

The study evaluates retrograde nail therapy as a novel option for distal tibia non-unions to avoid amputation.

## Key findings

- 75% of patients showed osseous consolidation after two years of treatment.
- 14% of patients underwent amputation despite the treatment.
- Retrograde nail therapy showed satisfactory fusion rates in difficult cases.

## Abstract

Compared to other long bones, non-unions of the tibia after fractures are more likely. Due to surgical debridement, the residual bone stock in the distal part of the bone may be insufficient for adequate fixation of an implant. Thus, treatment with a retrograde nail with the additional performance of an arthrodesis of the hindfoot may be an alternative. The aim of this study was to examine the consolidation and reinfection rates of non-unions of the distal tibia treated with a retrograde arthrodesis nail. A total of 27 patients between 2010 and 2018 were included according to our inclusion criteria. The modified Lane Sandhu Score was used for the radiographic evaluation. The osseous consolidation was validated after 1 year as well as after 2 years. Furthermore, we investigated differences in surgical treatment and treatment-associated complications. One year after the initial therapy 48% of the patients showed osseous consolidation, 75% showed consolidation after two years. 14% underwent amputation later. The majority of the patients (77%) received the ETN PROtect (Expert Tibia Nail PROtect) retrogradely, while the rest were obtained with the HAN (Hindfoot Arthrodesis Nail). Major revision surgeries were required in 26% of patients, while minor revisions were necessary in 15% of patients. In conclusion, treatment with a retrograde nail is a safe treatment option for distal tibia non-unions with a satisfactory overall fusion rate. Therefore, it can be an effective option especially in cases, where the fixation of the implant is difficult, in order to prevent amputation.