Transarticular stabilization for malunited fracture of the distal tibia in diabetics with loss of protective sensation.

Five diabetic patients who require insulin developed symptomatic malunited stress fracture of the distal tibia and fibula. All were treated with intramedullary fixation crossing the ankle joint. All progressed to stable union without evidence of infection. Two patients treated with antegrade intramedullary nailing required nail exchange for subsidence at the fracture site. One patient sustained a fracture at the proximal tip of a short retrograde nail, requiring replacement with a longer nail. Transarticular intramedullary fixation is an effective method of achieving stabilization for malunited fracture of the distal tibia in individuals with diabetes who are insensate. Due to the risk of fracture at the proximal tip of a standard short intramedullary nail, it is recommended to use a nail that extends to the proximal tibial metaphysis.