Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial

Abstract

PurposeThe purpose of this randomized clinical trial is to compare intramedullary nailing (IMN) versus minimally invasive plate osteosynthesis (MIPO) for the treatment of extra-articular distal tibial shaft fractures. Materials and methodsTwenty-five consecutive patients with distal extra-articular tibial fractures which were located between 4 and 12cm from the tibial plafond (AO 42A1 and 43A1) were randomly assigned into IMN (n:10) or MIPO (n: 15) treatment groups. All patients were followed for at least 1 year. Foot function index, time to weight bearing, union time, duration of operation, length of incision, intra-operative blood loss, intra-operative fluoroscopy time, rotational and angular malalignment, rate of infection, secondary interventions and complications were compared between groups. ResultsAll patients completed the trial and were followed with a mean of 23.1±9.4 months (range 12–52). Foot function index, weight bearing time, union time, rate of malunion, rate of infection and rate of secondary interventions were all similar between groups (p=0.807, p=0.177, p=0.402, p=0.358, p=0.404, p=0.404, respectively). Intra-operative blood loss, length of surgical incision, radiation time and rotational malalignment were higher in the IMN group (p=0.012, p=0.019, p=0.004 and p=0.027, respectively). ConclusionsResults of our study showed that both treatment methods have similar therapeutic efficacy regarding functional outcomes and can be used safely for extra-articular distal tibial shaft fractures, and none of the techniques had a major advantage over the other.