Abstract
INTRODUCTION: This study reports the successful application of distal tibial nail (DTN) for managing complex nonunions in open distal tibial fractures in patients with diabetes and a history of pin-site infection. PRESENTATION OF CASE: A 55-year-old diabetic female presented with an open left tibia-fibula fracture (Gustilo-Anderson Type IIIA) sustained in a car accident. She initially underwent debridement, suturing, and external fixation at a referring hospital. Postoperatively, the external fixation pin sites showed erythema, swelling, and discharge. Radiographs and CT scans revealed a tibial nonunion. Ten months post-injury, the tibial nonunion was successfully treated using the DTN, a novel technique. The distal tibia fracture achieved complete union postoperatively, allowing the patient to resume full weight-bearing and recreational activities such as running and jumping. DISCUSSION: To our knowledge, this is the first case report presenting the successful application of the DTN to treat nonunion following a Gustilo type IIIA open distal tibial fracture with prior pin-site infection and diabetes mellitus CONCLUSION: In this case, the DTN was effective in treating distal tibial nonunion, achieving satisfactory radiographic and functional outcomes. These findings suggest that DTN offers distinct advantages for the management of distal tibial nonunion, providing a valuable reference for clinical practice.