الفهرس 
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Abstract
Summary
Rising incidence of high velocity trauma due to motor vehicle accidents usually results in fractures of long bones. The tibia is the most commonly fractured long bone in the body.
Numerous treatment options exist for treating tibial fractures and good results have been reported with both conservative and surgical methods. To reduce the complications associated with conservative treatment, operative management of tibial fractures is preferred. Various operative methods like open reduction and plating, intramedullary nailing and external fixation have their own indications, advantages and disadvantages. When the aim is stable fixation with early restoration of function without use of plaster, intramedullary nailing, for internal fixation of diaphyseal and metaphyseal fractures of the tibia, offers an attractive treatment option. Intramedullary splinting provides the biomechanical principle of inter-fragmentary compression, support and adaptation to the basic principles of osteosynthesis. Interlocking nail has widened the range of indications for medullary osteosynthesis of tibial shaft fractures to include almost every type of fracture.
The Expert Tibial Nail System an intramedullary nailing system is indicated for fractures in the tibial shaft as well as for metaphyseal and certain intra-articular fractures of the proximal tibia and the distal tibia.
In addition to the standard static and dynamic locking options, Expert Nail features multi-directional locking options in the distal and proximal part of the nail. End cap block the most proximal screw creating an angular stable construct. Expert nail is having an option for compression at the fracture site (up to 7 mm) by inserting one distal locking screw and one proximal dynamic locking screw with a compression screw.
The aim of this study was to assess the clinical and radiological fracture healing and functional outcome of distal tibial fractures fixed by Expert tibial nail.
This prospective clinical study was conducted on 40 patients with distal tibial fractures. The study was conducted at Beni-Suef University Hospital and Al-Agouza Police Hospital.
The implant used is Expert Tibial Intramedullary Nail which has advanced nail design and five proximal locking options (three unique oblique and two medio-lateral locking options) and four distal locking options (Two medio-lateral, one antero-posterior and one additional oblique locking option, placed very distally).
All patients will be evaluated and examined preoperative and postoperative. Evaluation will be done two week post-operative, six weeks, 3-months and six months Then one year follow up.
Our results showed that:
According to post-operative data and the distribution of studied cases as per post-operative complications our results showed that Eight (20%) patients reported knee pain postoperatively, five (12.5%) patients reported superficial infection that treated by convenient antibiotics. None of patients experienced deep infection. One case had delayed union and non-union was observed in another one.
According to need of secondary procedures, our results showed that one patient needed secondary procedures while 97.5% were not.
According to full union, our results showed that the time to full union ranged from 12 weeks to 36 weeks with mean time (±SD) was 15.08± 3.84 weeks.
According to AOFAS score, our results showed that most cases (65%) showed excellent results according to AOFAS score, 13 (32.5%) cases had good results and one (2.5%) case showed poor results.
We concluded that treatment of distal tibial fractures using expert intramedullary nail with multidirectional distal locking screws is a safe and accepted method alternative to conventional nail and plating techniques.