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Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures

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Abstract

Purpose

To determine the effect of native tibia valga on intramedullary nail (IMN) fixation of tibial shaft fractures.

Methods

Retrospective comparative cohort analysis of 110 consecutive patients with tibial shaft fractures undergoing IMN fixation at an urban level one trauma centre was performed. Medical records and radiographs were reviewed for demographics, tibia centre of rotation of angulation (CORA), nail starting point, incidence of varus malreduction, and nail/canal proportional fit.

Results

Tibia valga (CORA of ≥ 3 degrees) was present in 37 (33.6%) patients. The anatomic nail starting point distance (in relation to the lateral tibial spine) was significantly greater in the tibia valga group (12.0 mm vs. 5.0 mm, mean difference: 7.1 mm, 95% CI: 5.8 to 8.3 mm, p < 0.0001). Varus malreduction was more common in the tibia valga group (10.8% vs. 1.4%, proportional difference: 9.4%, 95% CI: − 1.0 to 21.3%, p = 0.04). Varus malreduction in the tibia valga group was associated with a decreased nail width/inner canal width proportion on multivariate analysis (OR = 0.683, 95% CI: 0.468 to 0.995, p = 0.0004).

Conclusion

Native tibia valga is common, and the use of a standard coronal IMN starting point with poor nail fit can lead to iatrogenic varus malreduction. In patients with tibia valga, maximizing nail fit or utilization of a medial starting point should be considered.

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Fig. 1
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taken from the most distal aspect of the proximal fracture fragment. With inadequate nail fit, a lateral starting point in patients with tibia valga results in a nail with a medial trajectory that can induce varus malreduction upon insertion

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Availability of data and material

The data used in this study is not publicly available but can be made available upon reasonable request.

Code availability

The code for this study is not publicly available but can be made available upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    Nicholas J. Tucker, Cyril Mauffrey & Joshua A. Parry

  2. Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA

    Michael M. Hadeed

  3. University of Colorado School of Medicine, Aurora, CO, USA

    Cyril Mauffrey & Joshua A. Parry

Authors
  1. Nicholas J. Tucker
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  2. Michael M. Hadeed
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  3. Cyril Mauffrey
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  4. Joshua A. Parry
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All authors made substantial contributions to this work and give explicit consent for submission. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Joshua A. Parry.

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Ethics approval

Institutional Review Board approval was obtained prior to initiating this study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Due to the retrospective nature of this work, informed consent was waived.

Consent for publication

Due to the retrospective and de-identified nature of this work, consent to publish was waived.

Conflict of interest

The authors declare no competing interests.

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Level of Evidence: Level III, Retrospective cohort study

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Tucker, N.J., Hadeed, M.M., Mauffrey, C. et al. Native tibia valga: a potential source of varus malreduction during intramedullary tibial nail fixation of tibial shaft fractures. International Orthopaedics (SICOT) 46, 1165–1173 (2022). https://doi.org/10.1007/s00264-022-05356-7

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  • DOI: https://doi.org/10.1007/s00264-022-05356-7

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