Abstract
Aim: This is a prospective study of 30 patients with distal tibia fracture (Closed extra-articular distalthird tibia fractures - 4 to 11cm from tibial plafond) who underwent surgical fixation were included inthis study after excluding compound, pathological and pediatric fractures. Materials and Methods:15 underwent closed intramedullary interlocking nail and 15 were treated with plate osteosynthesis(MIPO). Results: The age distribution ranged from 23 to 68 years with the mean age of 39.4 years.The mode of injury in all patients was due to vehicle accidents. All 30 patients were classifiedaccording to AO classification of which 15 belonged to A1, 14 belonged to A2, and 1 belonged to A3.The time of fixation from injury varied from 6 hours to 18 days. Conclusion: Plate osteosynthesisby minimally invasive technique and Intramedullary interlocking nailing is an equally effectivemethod of stabilization for distal tibia fracture when considering the union rates and final functionaloutcome. However, malunion, nonunion and secondary procedures were more frequent afterintramedullary interlocking nail. In MIPO platting Infection followed by an exposed plate occurs in 2patients. Randomized prospective evaluation of distal tibia fractures may clarify the efficacy of plateversus nail treatment and optimize patient care.
Highlights
The mode of treatment of distal third tibial fractures is still controversial
The patient who underwent nailing showed a mean healing time of 24.9 weeks which has not shown any significant advantage over the healing time of patients treated with plate osteosynthesis by minimally invasive plating osteosynthesis (MIPO) technique which is 24.2 weeks [Table 2]
Distal tibial fractures that were treated with plate osteosynthesis especially after high energy injuries had encountered higher complication rates, because of which many surgeons preferred IM interlocking nailing techniques to minimize surgical insult to the fracture and adjacent soft tissue
Summary
The mode of treatment of distal third tibial fractures is still controversial. Distal third tibial fractures differ from proximal third fractures by their difference in anatomy and difference in healing potential [1]. Proximal and distal shaft fractures can be difficult to control with an intramedullary device, increasing the frequency of malalignment [4]. Concerns regarding difficulties with reduction/loss of reduction, inappropriate fixation in fractures with articular extension, anterior knee pain [5], and hardware failure have slowed the acceptance of intramedullary nailing as a treatment of fractures of the distal tibia. The recent innovation of nails with tip locking is a testimony that earlier nails were insufficient fixation tools for the distal tibia; tip locking is technically difficult and fractures that require it are essentially difficult to fix with nails [2,3,4,5,6]
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