Treatment of distal 1/3 tibia fractures: plating versus intramedullary nailing – A prospective comparative study

Abstract

Background: Tibia is the most commonly fractured bone amongst all long bones of the body due to its position and lack of soft tissue protection. Treating tibia distal 1/3rd fracture is still a greater challenge. Fracture of distal shaft without involving articular surface are of common occurrence but the management of these unstable extraarticular distal tibia fractures remains challenging. The mechanism of injury and the prognosis of these fractures are different from pillon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the treatment of tibial midshaft fractures. Methods: There were 73 patients of fracture distal 1/3 tibia were enrolled during 2-may-2015 to 31-Dec-2016 in the study . They were randomly divided into two groups, there were 30 patient treated with distal tibia tip locking nail and distal 43 patient treated with distal tibia plate. The patients were followed up every four weeks till radiological union was seen. At every follow up clinical examination was done to assess status of the surgical wound, pain, tenderness, range of motion of ankle, stability of the fracture and clinical union. X rays were taken in AP and Lateral views to look for signs of radiological union. The union is confirmed radiologically when plain X-ray showed bone trabaculae or cortical bone crossing fracture site on at least three surfaces on orthogonal radiograms. The functional outcome was assessed by. The American Orthopedic Foot and Ankle Society Score (AOFAS). Results: There were total 73 patients among them 43 (58.9%) treated with open reduction and internal fixation with distal tibia plate and 30 (41.1%) treated with intramedullary tip locking nail. The mean age of patient treated with plat was 39.98 years (SD+-9.64, Min-Max : 25-60) and treated with nail was 41.2 years (SD+-10.28, Min-Max : 22-61). Conclusion: Our study suggest platting is more effective method for extra articular closed distal 1/3 tibia fracture than intramedullary tip locking nail according to functional outcome with minimal postoperative complication