Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures

Abstract

Background: The tibia constitutes one of two bones of the leg. Recently, minimally invasive percutaneous medial locked plating has been described in the literature with promising results. Expert Tibial Nail currently represents an effective approach to the treatment of complex extraarticular distal tibial fractures. Hence; the present study was undertaken for comparing the results of Expert Tibial nailing with results of Distal Tibial Plating in patients with Distal 1/3rd extraarticular Tibial Fractures. Materials & Methods: The study was conducted on 40 patients with extraarticular distal 1/3rd tibia fractures. All the patients were divided into two study groups randomly with 20 patients in each group as follows: Expert Tibial Nailing group, & Distal Tibial Plating group. All the patients underwent procedures according to their respective study groups. During the postoperative phase, static quadriceps exercises & toe movements, as tolerated were started from 1st postoperative day. Full weight-bearing was allowed after 10 to 12 weeks, depending on the radiographic signs of fracture healing. Patients were followed up for 6 months after operation and evaluated as per Johner and Wruss Criteria. Results: The mean age of the patients of the expert tibial nailing group and distal tibial plating group was 48.12 years and 49.71 years respectively.Mean operative time among the patients of the expert tibial nailing group was 83.15 minutes and was significantly lower in comparison to the patients of the distal tibial plating group (101.2 minutes). Mean intraoperative blood loss was compared between expert tibial nailing and distal tibial plating. Torniquet was used in all the cases. Mean intraoperative blood loss among the patients of the expert tibial nailing group was 51.6 ml and was significantly lower in comparison to the patients of the distal tibial plating group (89.1 ml). Mean postoperative weight-bearing time among the patients of expert tibial nailing was 8.95 weeks and was significantly lower in comparison to the patients of the distal tibial plating (14.35 weeks). Mean fracture union time among the patients of the expert tibial nailing group was 18.6 weeks and was significantly lower in comparison to the patients of the distal tibial plating group (25.84 weeks). Excellent results were obtained in 80 percent of the patients of the expert tibial nailing group and 55 percent of the patients of the distal tibial plating group respectively. Conclusion: The results of present study with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enable it to use in proximal and distal metaphyseal fractures of tibia.