Plate or nail for distal tibia fractures: Is there a clear answer?

Abstract

Controversy still exists about the relative merits of the fixation devices for distal tibia fractures, and decision making remains difficult. This study aims to answer the question and find out when each implant is preferred. Of the patients treated at our hospitals for distal tibia fractures, 30 patients treated by minimally invasive plate osteosynthesis (MIPO) (group A) were matched to 30 patients treated by static reamed intramedullary nail (SR-IMN) (group B), with regard to age decade, gender, fracture type (open or closed), the AO/OTA classification of the fracture, and occupation category. No significant difference was found between the two groups regarding bone union and complications including angulation of >5°, shortening of >1 cm, implant failure, fixation loss, or deep infection. Group A had a shorter mean operative time and mean radiation exposure time. Group B had a shorter mean time from trauma to surgery and faster full weight-bearing, radiographic union, and return to work. Only three patients lost their previous job, two in group A and one in group B. Both implants are useful and effective. The clear answer is that no best implant and preoperative planning is the cornerstone to determine the patient, fracture, and surgeon factors that give priority for one implant over the other.