Functional Outcome with Surgical Management in Distal Tibia Fracture

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Introduction: Distal Tibia fractures continue to be one of the most controversial fractures that we treat. Most of the controversy resides in the treatment techniques, as the indication for surgery is fairly clear. Plate osteosynthesis with Minimally invasive plate osteosynthesis(MIPPO) principle for fractures of the distal tibia is often associated with good healing but infection, and hardware problems.Locked intramedullary nailing is the treatment of choice for closed fractures of the tibial shaft .For proper alignment, the nail should be centrally placed in both the proximal and distal fragments ,but does not fit properly into the distal fragment of the lower third of the tibia. This places additional stress on the distal locking bolts and may lead to breakage and malalignment.AIMS AND OBJECTIVES; The main aim of the study is to compare the functional recovery of the patients who had distal extraarticular fracture ,AO type 43A treated with Intramedulary interlocking nail and plate osteosynthesis (Mippo). Also The aim of treating a fracture is to produce a stable construct which allows early mobilisation and weight-bearing, but with minimal complications.MATERIALS AND METHODS; This study was done in the department of orthopedics from June 2010 to January 2013 in young age above 18yr and below 60 yr. which includes 30 patients with distal tibia fractures. Patients having fracture of distal tibia at metadiaphysial area.1.Extraarticular fracture, minimum of 3cm of distal fragment 2.Age above 18yrs and less than 60yr old3.Open fracturegustilo Anderson type 1 and type2SUMMARY; In this study 30 cases of distal tibia fracture were treated surgically with internal fixation with IMIL nail for 15 case and ORIF plating for 15 cases. In our study of30 cases AO Type 43 , 12 case were type A1,9 (76%)patients operated with IMIL nail and 3(23%) patient with plating. Type A2 we had 12 cases out of which 5 patients(41.6%) treated with nail and 7 patient(58.3%) treated with plate.TypeA3 we had 6 cases.one case 16.6% treated with nail and 5 cases 83.3% with plate. We faced more malalignment(11.11%),delayed union(16.6%),non union(5.5%),secondary procedure( 22.2%)done for the complication was more with nail .where as with plate group we never had significant malalignment.Had one delayed union(32weeks) for which no secondary surgery done,One superficial skin necrosis of surgical site .CONCLUSION;In study of distal tibia fractureOTA\AO 43 Type A ,we compared with both nail and plate surgery. We conclude that segmental alignment is difficult with nail due ankle joint is near ,more distal the fragment difficult to treat with nail. Because of more complication associated with nail than plate.We conclude plating in distal tibia fracture AO 43 TypeA is safe and provide better alignment than nail.