Expert tibial nail (ETN) versus minimally invasive plate osteosynthesis techniques in the treatment of distal tibia fractures in young adults: A randomized controlled trial

Abstract

Abstract Purpose To compare anatomical locked plates inserted in a minimally invasive pattern (MIPO) versus expert tibial nailing (ETN) for fixation of extra-articular fractures of the distal tibia in young adults. Patients and methods The study included 120 patients, 84 males and 36 females. The mean follow-up time was 13.5 months, with at least 12 months of follow-up. Cases were equally divided and randomized by the closed-envelope technique into two groups, group A: fixed by anatomical locked plate through a minimally invasive approach, and group B: fixed by ETN. Results The average operative time was significantly higher in the MIPO group (94 min) compared with the ETN group (81.67 mins). Also, the radiological exposure time was also higher (87.6 secs) in group A versus 78.4 in group B. Although there was an incidence of deformity in few cases of the ETN group (eight patients), that was not significant enough to warrant correction by revision surgery. There were no significant differences in the union time (P value: 0.09) and American Orthopedic Foot and Ankle Society (AOFAS) scores (P value: 0.78) between the two groups. Furthermore, the infection and the need for further surgeries did not show significant differences among both groups. Conclusion Both MIPO and ETN are valid treatment options for distal tibia fractures, AO type 43 A. Both methods resulted in acceptable union time, and American Orthopedic Foot and Ankle Society scores, with no reported cases of nonunion. Level of evidence. Therapeutic study, level I