LCP as supracutaneous plate vs IMLN tibia for open grade 1 and Ⅱ distal tibial fractures. A comparison study (RCT) on Functional outcome between a conventional method and a Novel technique

Abstract

Introduction Orthopaedics is an ever evolving branch. Especially for fractures that have controversies in management options, recent advances are being done. Open distal tibial fractures belong to these groups of difficult, yet very common injuries. As the necessity is the mother of invention, for such a common injury a common plate-LCP was used supracutaneously for better biological fixation and shorter duration of surgery. We have compared the results of IMLN nailing vs supracutaneous plating for open distal tibial fractures. Material and methods The patients who had Gustilo and Anderson type 1 and 2 # of distal tibia were enrolled in this study. They were randomized into 2 groups. In one group (IMLN) intramedullary locking nail and in another group Supracutaneous plating was done (SCP). Duration of clicnal and radiological union was calculated. Functional outcome in both groups was measured in AOFSAS score, Knee Society Score (KSS),Lower extremity functional scoring (LEFS) and Ketenjian and Shelton Criteria modified by Yokoyama. Any complications were charted. Results 100 % fracture union was seen in both cases. Intra operative blood loss was 165 ml and was more in IMLN group than SCP group (100) ml. LEFS at 1 year was 90 in SCP group whereas it was 80 in IMLN group. AOFAS score was similar in both groups showing good functional outcome around ankle joint. Knee society score was statistically better in SCP group (82) whereas in IMLN group it was 70. Incidence of infection and surgical duration was similar in both groups.Due to need for removal in some cases duration of stay was more in IMLN. Conclusion Patients in SCP Group had lesser incidence of persistent pain or other chronic symptoms and were happier (better LEFS score, better Yokahama scoring) than their counterparts with interlocking nail. Using locking plate in a supracutaneous mode is a very simple, easy, rapid, reliable and effective method for management of open tibial fractures in adults, especially in terms of patient satisfaction and can be considered as an effective alternative to nailing in selected patients.