Intramedullary nail versus plate in osteosynthesis of distal tibial shaft fractures in adults

Abstract

Objective To compare the efficacy between intramedullary nail and plate in the internal fixation for distal tibial shaft fractures in adults. Methods A retrospective analysis was conducted of the 49 patients with distal tibial shaft fracture who had been treated by internal fixation with intramedullary nail or plate at Department of Orthopaedics, The First People＇s Hospital of Neijiang from September 2014 to September 2018. They were 26 males and 23 females, aged from 19 to 71 years (average, 42.3 years). According to the AO/ASIF classification, there were 34 cases of type 43A1 and 15 cases of type 43A2. There were 7 open and 42 closed fractures. Of them, 23 received intramedullary nailing and 26 steel plating. The 2 groups were compared in terms of intraoperative blood loss, operation time, hospitalization time, fracture healing time, The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, infection and fracture malunion. Results The 2 groups were comparable because there were no significant differences in the preoperative general data between them(P>0.05). The intraoperative blood loss in the intramedullary nail group (160.3 mL ± 15.2 mL) was significantly greater than that in the plate group (110.5 mL ± 13.4 mL) (P 0.05). There were no significant differences between the 2 groups either in the rates of malunion, infection or internal fixation failure (P>0.05). Five cases in the intramedullary nail group reported painful discomfort in the front of the knee joint while 7 cases in the plate group postoperative discomfort due to plate protrusion. Conclusions Both intramedullary nail and plate are effective treatments of adult distal tibial fracture. However, in order to minimize the risk of infection, intraoperative maneuvers should be as careful and gentle as possible, repeated violence be avoided and soft tissues be carefully protected. Key words: Tibia fracture; Fracture fixation, internal; Bone nail; Bone plate