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Purpose <p>The purpose of this study was to compare clinical outcomes following intramedullary nailing (IMN) of tibial shaft fractures with an associated, operatively treated distal syndesmotic injury to isolated tibial shaft fractures treated with IMN.</p> Methods <p>Patients treated with IMN for a tibial shaft fracture with concomitant operative repair of a syndesmotic injury between 2010 and 2024 were identified from an institutional database of two Level 1 trauma centers. A comparison cohort of patients treated with IMN for isolated tibial shaft fractures was identified from a previously published database spanning 2021–2023. The primary outcome was the rate of postoperative complications (infection, reoperation, malunion, and nonunion).</p> Results <p>Twenty-four patients who underwent IMN for a tibial shaft fracture with concomitant operative repair of a syndesmotic injury and 89 patients who underwent IMN for an isolated tibial shaft fracture were identified. The overall median age was 39&#xa0;years (IQR: 28–55), 60 patients (53%) were male, and 34 (30%) fractures were open. Patient and injury characteristics were not significantly different between groups. Patients with associated syndesmotic injury were recommended non-weightbearing more often (79% vs. 36%, <i>p</i> &lt; 0.001). Patients with concomitant operative repair of a syndesmotic injury had 3.9-fold increased odds of undergoing symptomatic implant removal compared to isolated injuries (95% CI 1.14–13.2, <i>p</i> = 0.027). Odds of reoperation for deep and superficial infection, and rates of nonunion and malunion were similar between groups.</p> Conclusions <p>Patients undergoing intramedullary nailing for tibial shaft fractures with an associated, operatively treated distal syndesmotic injury should be educated on the higher odds of undergoing implant removal compared to isolated tibial shaft fractures. The observed rate of implant removal was similar to those reported following syndesmotic fixation for ankle injuries. Other complication rates, including nonunion, malunion, and infection, were similar.</p>

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Tibial shaft fractures with associated syndesmotic injury: a retrospective comparative analysis of 113 patients

  • 期刊论文

  • 发表日期：

    2026年2月2日

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  • Varun Aysola,
  • Jacob S. Borgida,
  • Robert K. Wagner,
  • Adam N. Musick,
  • Austin T. Gregg,
  • Derek van Duuren,
  • Whitney H. Smith,
  • Carla H. Lehle,
  • Healy S. Vise,
  • Alice W. Wong,
  • Derek S. Stenquist,
  • Arun Aneja,
  • Thuan V. Ly

摘要

Purpose

The purpose of this study was to compare clinical outcomes following intramedullary nailing (IMN) of tibial shaft fractures with an associated, operatively treated distal syndesmotic injury to isolated tibial shaft fractures treated with IMN.

Methods

Patients treated with IMN for a tibial shaft fracture with concomitant operative repair of a syndesmotic injury between 2010 and 2024 were identified from an institutional database of two Level 1 trauma centers. A comparison cohort of patients treated with IMN for isolated tibial shaft fractures was identified from a previously published database spanning 2021–2023. The primary outcome was the rate of postoperative complications (infection, reoperation, malunion, and nonunion).

Results

Twenty-four patients who underwent IMN for a tibial shaft fracture with concomitant operative repair of a syndesmotic injury and 89 patients who underwent IMN for an isolated tibial shaft fracture were identified. The overall median age was 39 years (IQR: 28–55), 60 patients (53%) were male, and 34 (30%) fractures were open. Patient and injury characteristics were not significantly different between groups. Patients with associated syndesmotic injury were recommended non-weightbearing more often (79% vs. 36%, p < 0.001). Patients with concomitant operative repair of a syndesmotic injury had 3.9-fold increased odds of undergoing symptomatic implant removal compared to isolated injuries (95% CI 1.14–13.2, p = 0.027). Odds of reoperation for deep and superficial infection, and rates of nonunion and malunion were similar between groups.

Conclusions

Patients undergoing intramedullary nailing for tibial shaft fractures with an associated, operatively treated distal syndesmotic injury should be educated on the higher odds of undergoing implant removal compared to isolated tibial shaft fractures. The observed rate of implant removal was similar to those reported following syndesmotic fixation for ankle injuries. Other complication rates, including nonunion, malunion, and infection, were similar.