Top 10 Distal Tibial Intramedullary Nails (DTN) in North America for January 2025

Locking Plates

Significant soft tissue damage, high infection rate, long recovery

Antegrade Nails

Risk of knee joint injury, inadequate fixation, prone to malalignment

DTN Solution

Minimally invasive approach with retrograde insertion design

1Distal tibial fractures are common, and traditional treatments have limitations

Distal tibial fractures are a common type of lower limb fracture. Traditional treatments such as locking plates and antegrade intramedullary nails each have their drawbacks. Locking plates may cause postoperative infections or soft tissue necrosis, prolonging recovery; although antegrade nails are minimally invasive, they may damage the knee joint, cause pain, and carry risks of inadequate fixation or malalignment, hindering recovery.

2New solution: Distal Tibial Nail (DTN)

A novel treatment option—Distal Tibial Nail (DTN)—offers a new perspective for managing distal tibial fractures with its unique retrograde design.

Fig. 1: DTN retrograde insertion design

1Patient positioning and reduction preparation

The patient is placed in the supine position. Displaced fractures should be reducible manually; if necessary, use reduction forceps to assist before inserting the DTN. If there is an accompanying fibular fracture, proper fibular alignment can aid tibial reduction.

2DTN insertion procedure

A 2–3 cm longitudinal incision is made at the tip of the medial malleolus to expose the superficial deltoid ligament. A guide pin is inserted at or slightly medial to the tip of the malleolus, 4–5 mm from the articular surface.

Fig. 2a: Guide pin insertion

Fig. 2b: Lateral view

Fig. 2c: Reaming process

Rehabilitation Protocol

• Ankle joint activity starts immediately after surgery

• Avoid weight-bearing for 4–6 weeks

• Gradual transition to full weight-bearing at 8–12 weeks

• Regular radiographic monitoring during recovery phase

1Clinical Outcomes of 10 Patients

A study followed 10 patients. By 3 months post-op, 7 cases had healed; all patients achieved healing within 6 months. One case each of varus and recurvatum deformities occurred. No loss of reduction, infection, implant-related complications, or iatrogenic injuries were observed.

1Biomechanical Stability

Retrograde nails have superior axial and rotational stiffness compared to medial locking plates and antegrade nails. Greenfield et al. conducted biomechanical testing showing that using two distal screws in the DTN achieved 60–70% of the compressive stiffness and 90% of the torsional stiffness compared to three screws.

2Advantages of DTN

Compared to locking plates, intramedullary nails cause less soft tissue damage, particularly suitable for elderly patients and those with severe soft tissue injuries from high-energy trauma. The procedure does not require knee flexion, reducing the risk of reduction loss and making it suitable for patients with limited knee motion.

3Clinical Comparison

The nonunion and malalignment rates for antegrade nails are 0–25% and 8.3–50%, respectively; for locking plates, 0–17% and 0–17%. In this study, all cases achieved union, and only 20% had deformity >5°, comparable to traditional methods.

DTN Product Line

Distal Tibial Intramedullary Nail (DTN)

Model: T1100-59

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Distal Tibial Intramedullary Nail (DTN) Instrument Set

Model:1200-27

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Distal Tibial Intramedullary Nail (DTN) Instrument Box

Model:1000-0139

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