Abstract: Objective    To compare the clinical efficacy of retrograde tibial intramedullary nail and antegrade tibial intramedullary nail in the treatment of patients with extra-articular distal tibial fractures. Methods    A retrospective review was conducted for 56 patients admitted to our department with extra-articular distal tibial fractures between August 2020 to August 2022. Twenty-three patients were treated with retrograde intramedullary nail fixation and 33 patients were treated with anterograde intramedullary nail fixation. Baseline characteristics, surgical time, fluoroscopy frequency, hospital stay, fracture healing time, complete weight-bearing time, distal tibial articular surface angulation, American Orthopedic Foot and Ankle Society (AOFAS) score at the last follow-up, and other complications were recorded and compared between the two groups.    Results    All patients were followed up for 12-20 months. In the retrograde intramedullary nail group, the average distance of the fracture line to the distal tibial articular surface was shorter than that of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.001). There was no statistically significant difference in other general clinical data between the two groups of patients. The average number of fluoroscopy times in the anterograde intramedullary nail group was higher than that in the retrograde intramedullary nail group, and the difference was statistically significant (P=0.001). The complete weight-bearing time and fracture healing time of the retrograde intramedullary nail group were better than those of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.002 and P=0.018). There were 4 cases of postoperative complications in the retrograde intramedullary nail group and 10 cases in the anterograde intramedullary nail group, with no statistically significant difference in the incidence of complications.   Conclusions    Both retrograde and antegrade intramedullary nails are effective methods for treating extra-articular distal tibial fractures. Retrograde intramedullary nails have the advantages of number of intraoperative fluoroscopy, complete weight-bearing time, and fracture healing time.

Key words: Extra-articular distal tibial fractures; ,  , Retrograde tibial intramedullary nails; ,  , Antegrade tibial intramedullary nails; ,  , Full weight-bearing; ,  , Fracture union; ,  , Minimally invasive treatment