Surgical dilemma's in treating distal third leg fractures

Abstract

Background: Of all the long bones, the tibia and fibula have the highest incidence of fractures. These fractures are often caused by high energy trauma. The management of tibial fractures has always been particular interest to orthopaedic surgeons because they are relatively common but difficult to treat. The spectrum of injuries to the tibia is so diverse that there is no single method of treatment applicable to all fractures. In this we are going to analyse distal tibia fracture treated by nailing and minimally invasive plate osteosynthesis. Methods: A prospective study done at Sri Ramachandra Medical Centre between June 2011 and June 2013. The inclusion criteria were closed extra - articular distal third tibia fracture. The exclusion criteria were compound fractures, intraarticular fractures, paediatric fractures and pathological fractures. We had fifteen patients who underwent closed intramedullary interlocking nail and fifteen patients treated with plate osteosynthesis (MIPO). Results: All the fractures united solidly with mean union time of 24.5 weeks ranging from 18 to 38 weeks. The patient who underwent nailing showed mean healing time of 24.9 weeks which has not shown any significant advantage over the healing time of patients treated with plate osteosynthesis by MIPO technique which is 24.2 weeks. In nailing group the infection rate was 20% which is significantly higher when compared to patients who were treated with plate osteosynthesis 6.6%. Conclusion: Plate osteosynthesis by minimally invasive technique and intramedullary interlocking nailing are equally effective methods of stabilisation for distal tibia fracture when considering the union rates and final functional outcome. However malunion, nonunion and secondary procedures were more frequent after intramedullary interlocking nail. Concurrent fibula fixation with plate osteosynthesis will minimise the incidence of malunion for distal tibia fractures.