Intramedullary Nailing Versus Plating in the Management of Extra Articular Distal Tibial Fractures

Abstract

Background:Distal tibial fractures are the most common long bonefractures. An incidence of 17 per100 000 person-years, although more recent dataindicate that the incidence may be declining.

Tibial plating using a ‘locking’ plate can achieve accurate reduction, the need for greater soft tissue dissection increases the risk of infection, wound breakdown, and damage to the surrounding structures.

Aim of the study:To find out the best management and improving outcome of extra articular distal tibial fracture.

Patients and methods:This study carried out as a non-randomized controlled clinical trial in which we compared the functional outcome and complication rate between two techniques (nailing versus plating) for the treatment of extra-articular fractures of the distal tibia in an adult population. This study involved 2 groups of patients; each group included 9 patients with tibial fracture. Group I had fracture fixed by intramedullary nail (ILN group); the other was fixed by plate (MIPPO group). Nailing group included 6 males and 3 females and plating group included 9 males. As males are more frequently exposed to outdoor activities and hence more involved in road side accidents and industrial misfortunes.

Results:There was a statistically significant difference between the studied groups regarding classification of tibial fracture. 43A1, 43A2 and 43A3s types occurred in 77.8%, 22.2% and 0% within nail group versus 22.2%, 66.7% and 11.1% within plate group respectively.But there was statistically significant difference between both groups regarding operative time (88.9 minutes versus 71.11 minutes within nail and plate groups respectively).Regarding union, there was statistically non-significant difference between the studied groups regarding time or score of union. Means time for weaning were 13.13 versus 15.33 weeks within nail and plate groups respectively. Mean union scores were 11.22 and 11.33 within nail and plate groups respectively. No patient within either group need reoperation.

Conclusion:both medial distal tibial locking plate and closed intramedullary interlocking tibia nailing are appropriate treatments of extra-articular distal tibia fracture (EDTF), with each having its own merits and demerits.

Plate fixation and IM nailing were safe and effective treatment options for EDTF because both of them could provide a similar good function outcome. IM nailing should be taken priority for EDTF with serious soft tissue injury. MIPO should be taken priority for EDTF with distal fragment didn't enough for using of distal locking screws of expert nail.