Abstract
Purpose:This study aimed to compare the clinical, radiologic, and cost-effectiveness results between locking and non-locking plates for the treatment of extra-articular type A distal tibial fractures.Methods:We performed a retrospective review of AO/OTA 42-A1, A2 distal tibial fractures treated by plates from January 2011 to June 2013. Patients were divided to the locking plate group or the non-locking plate group. Clinical outcomes, radiographic outcomes, and hospitalization fee were compared between the two plates groups.Results:28 patients were treated with a locking plate and 23 patients were treated with a non-locking plate. The mean follow-up was 18.8 months (12-23 months). There were no significant differences between the groups in surgical time, bleeding, bone union time, or AOFAS scores. The cost of the locking plate was ¥24,648.41 ± 6,812.95 and the cost of the non-locking plate was ¥11,642 ± 3,162.57, p < 0.001. Each group had one patient that experienced superficial infection these wounds were readily healed by oral antibiotics and dressing changes. To date, five patients in the locking group and ten patients in the non-locking group had sensations of metal stimulation or other discomfort (X2 = 3.99, p < 0.05) Until the last follow-up, 14 patients in the locking plate group and 18 patients in the non-locking plate group had their plates removed or wanted to remove their plates (X2 = 4.31, p < 0.05).Conclusion:The use of locking or non-locking plates provides a similar outcome in the treatment of distal fractures. However the locking plate is much more expensive than the non-locking plate.
Highlights
Fractures of the distal third of the tibia are common
There was no significant difference between the groups in surgical time, bleeding, bone union time, or AOFAS scores
Implant removal was necessary in 14 cases (50%) and 18 (78%) cases in the locking plate group and non-locking plate group because of local pain and/or skin irritation related to plates and screws
Summary
Fractures of the distal third of the tibia are common. They represent about 3-10% of all tibial fractures [1]. Intramedullary nail fixation for most fractures is still the gold standard [2], but if the marrow cavity is too small or the fracture line is near the joint surface, we just only can use the plates to to treat the fractures. AO/ASIF type 42-A1 and A2 fracture of the distal tibia is a simple fracture. According to the AO principles of fracture management, simple fracture needs anatomical reduction, strong fixation, absolute stability, and primary healing. The traditional technique of open anatomic reduction and internal fixation of distal tibial fractures requires extensive soft-tissue dissection and often leads to subsequent periosteal injury. High rates of complications, including postoperative infection, delayed union, and
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