Comparative study between intramedullary nailing and plating for extra articular distal tibia fractures

Abstract

Background: Distal third tibial fractures remain challenging due to peculiar soft tissue features and myriad treatment options. Tibia is not only the most common long bone of body to get fractured but also offers many challenges to Orthopaedic surgeons in managing its fractures. The surgical treatment itself has controversies such as difficulty in achieving and retaining good reduction by nailing methods, propensity to infection and nonunion due to dissecting the fracture site during the procedure of inserting the plate. There are various options available for the surgical management of distal 1/3rd tibial shaft fractures and each of these treatment options is associated with certain challenges. Method: We studied the 60 patients of distal 1/3rd tibial shaft fractures operated with closed reduction and internal fixation with reamed intramedullary interlocking nailing or open reduction internal fixation with plating. The patient selection was done by randomisation. Radiological outcomes and clinical outcomes using Olerud-Molander score were assessed at 6 weeks, 3 months, 6 months and 1 year intervals Result: Mean for surgery duration in minutes was 68 and 75 in patients who underwent interlocking nailing and plate osteosynthesis respectively. Mean time of union was found to be 14.2 weeks in patients treated with interlocking nail and 18.1 in patients treated with plate osteosynthesis. We found out that 20% patients had good & 80% patients had excellent outcome treated with interlocking nail according to Olerud-Molander Score in comparison with patients who underwent plate osteosynthesis had good outcome in 36.7% patients and excellent outcome in 63.34% of patients. Complications were seen mostly in plate osteosynthesis group of patients that included superficial infection and hardware impingement in 2 patients each and wound dehiscence was seen in 1 patient. Hardware impingement was seen in one case on patient who underwent interlocking nail. Conclusion: Our results have shown that both closed intramedullary nailing and locking plating can be used safely to treat fractures of the tibia. Closed nailing has the advantage of shortened operating time, decreased wound problems, early union of the fracture, decreased implant related problems & overall reduced morbidity, therefore we prefer closed intramedullary interlocking nailing in treatment of extra-articular distal tibia fractures.