Knee and ankle function after displaced non-isolated fractures of the tibial shaft, a retrospective comparison between plate fixation and intramedullary nailing.

Abstract

Knee and ankle function after tibial shaft fractures have not been evaluated comparing intramedullary nailing (IMN) and plate fixation (PF). In a retrospective case review study we evaluated 50 patients with history of closed tibial and fibular shaft fracture who have been treated by IMN or PF from 1999 to 2003. Twenty-five patients in each group evaluated for knee and ankle function using Iowa knee score, ankle rating score and VAS for the pain. 18.3±4.8weeks after PF (mean follow up 35±11.7) and 16.4±4.6weeks after IMN fixation (mean follow up 36.8±11.3) union has been achieved (P<0.17). The knee score was 89.4±10.4 in IMN group and 95.7±6.7 in PF one (P<0.01). The ankle rating score was 94.7±7.2 in IMN and 96.8±6.1 in PF (P<0.28). The nail to knee distance (average 14±5.2mm) was significantly correlated to the knees' function and pain (r=0.599, P<0.002, r=0.583, P<0.002, respectively). T-test reveals that knees' function are significantly inferior with transpatellar approach in comparison with parapatellar one (86.1±10.6 vs. 95.3±7.4, P<0.01). Our study discloses that using plate may lead to better knee function, while IMN causes higher amount of knee pain with controversial reasons.