Nail In Treatment Research Articles

Understanding the drug delivery through nails: a comprehensive review

The nail unit is the largest cutaneous musculo-skeletal appendage. The management of nail disorders is an onerous task owing to the disease manifestations and anatomical structure of the nail plate. The topical treatment of nail infections/disorders has been a centerpiece of nail research in the past few decades as it offers a much safer and focused alternative to conventional oral therapy. However, transungual delivery had its challenges. This necessitated a lookout for novel approaches that enhanced treatment efficacy and reduced treatment time. Moreover, curing the nail condition using topical delivery has been challenging due to the lack of a validated animal model to determine the efficacy of the formulation and to establish a mathematical model that can help in predicting the desirable attributes of the formulation and permeation of various molecules through the nail plate. This review is based on publications retrieved by a selective search in PubMed. The purpose of this review is to provide an overview of nail anatomy and its disorders, factors affecting nail delivery, diagnostic procedures, current approaches, and promising approaches to treat nail infections/disorders including nail lacquers and the role of permeation enhancers, in-vitro models. This review also covers current available treatments and treatments under clinical trial.
 Keywords: Musculo-skeletal, Nail infection, Transungual, Mathematical model, In-vitro models.

Parrot Beak Nail: Case Report and Review of Parrot Beak Nail Dystrophy

Parrot beak nail dystrophy is an excessive forward curvature of the nail plate that can affect both fingernails and toenails. Few cases have been reported since its original description in 1971; however, the incidence is estimated to be 2.5% in healthy individuals. Although the pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail. We describe an 86-year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail. He had stopped visits with his podiatrist for nail care, which fostered the growth of these nail dystrophies. Our patient’s parrot beak nail was successfully treated with nail clipping and regular nail maintenance to prevent its recurrence. The associated conditions, etiologies, and treatment of parrot beak nails are discussed.

Clinical Performance of Intramedullary Nailing system for Tibia Fractures: A Retrospective study

Background: The tibia, or shinbone, is the common fracture long bone in body. There are two option includes, reamed and unreamed of surgical treatment of fractures. Reamed nail has some advantage but they significantly harmful the endosteal circulation. Unreamed nail surplus the endosteal circulation but provide a less stable fixation. Afterward, because of ability to lock the nail proximally and distally, closed intramedullary nailing turned into an acknowledged treatment for closed shaft cracks during the ninth decade. Aim: The main objective is to treat the tibia fractures by implanting the Intramedullary nailing system (Interlocking cannulated tibia nail and Expert tibia nail) manufactured by Auxein Medical Private Limited, Sonipat, India. Material and Methods: In this retrospective study, studied the results of intramedullary tibia nail in treatment of tibia fracture. A total of 25 consecutive patients were included in this study (11male, 14 female and average age 42.9 years). Fracture type was classified as per the Muller AO classification of fracture. Results: The outcomes of clinical treatment were obtained in our study; No pain (92%), Mild pain (8%) after 2 year follow up. The follow up of patients were taken on 4-week, 1-year, 2-year according to VAS score. Paired t test was performed for statistical data analysis using Minitab and values of p<.05 were taken to indicate significant value with confidence interval of 95%. No implant related problem have been found like loosening, bending, corrosion etc. Conclusion: Our outcomes with interlocking cannulated and Expert tibial interlocking nailing are empowering and exhibit the advantages of new nailing framework. It has been concluded that intramedullary tibia nailing system is best method for treatment of tibia fracture with good results and outcomes.

Successful results obtained in the treatment of adolescent forearm fractures with locked intramedullary nailing

PurposeIn the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures. MethodsA retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture. The included patients were in the adolescent age group (12–17 years), did not meet conservative follow-up criteria and had unstable fractures (>10° angulation and <50% cortex continuity after plaster casting). Patients were excluded from the study if they were aged >18 years or <12 years, had Gustilo-Anderson type 2/3 open fractures, multi-trauma, history of physeal injuries or could not be contacted during follow-up. Patients’ age, gender, body mass index, affected side, and the pronation and supination values during follow-up were noted. Functional evaluation of the patients was performed with disabilities of the arm, shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria. The time to union, infection during follow-up, re-fracture and vascular nerve damage were also examined. Data were analyzed using SPSS 22 Windows package program software. ResultsThe patients comprised 30 males and 6 females (ratio, 5:1) with a mean age of (14.7 ± 2.1) years (range, 12–18 years). According to the Price criteria, the results of 33 patients were excellent, 3 were good and there were no moderate or poor cases. The mean disabilities of the arm, shoulder and hand score was 11.2 ± 6.1 (range, 4–28). The mean time to union was (8.7 ± 2.2) weeks (range, 6–14 weeks), while patients aged >15 years had prolonged time to union ([11.1 ± 1.8] weeks). There were no non-unions, re-fractures or infections. No complications were observed during implant removal. None of the patients had sensorial radial nerve injury or tendon damage. ConclusionThe locked intramedullary nailing technique, which is minimally invasive and provides biological fixation, was found to be successful and safe in the treatment of adolescent forearm fractures.

Clinical performance of intramedullary nailing system for tibia fractures: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In this study, we aimed to investigate the performance of the intramedullary tibia nailing system while treating the tibia fracture fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective study, studied the results of intramedullary tibia nail in treatment of tibia fracture. A total of 25 consecutive patients were included in this study (11 male, 14 female and average age 42.9 years). Fracture type was classified as per the Muller AO classification of fracture.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The outcomes of clinical treatment were obtained in our study; no pain (92%), mild pain (8%) after 2 year follow up. The follow up of patients were taken on 1 month, 6 months, 1 year and 2 years according to visual analog scale (VAS) score. Paired t test was performed for statistical data analysis using minitab and values of p&amp;lt;0.05 were taken to indicate significant value with confidence interval of 95%. No implant related problem have been found like loosening, bending and corrosion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our outcomes with interlocking cannulated and expert tibial interlocking nailing are empowering and exhibit the advantages of new nailing framework. It has been concluded that intramedullary tibia nailing system is best method for treatment of tibia fracture with good results and outcomes.&lt;/p&gt;

Proximal femoral replacement: A salvage treatment of cephalomedullary nails’ mechanical failures in the elderly population

BackgroundThe use of proximal femoral replacements (PFR) has been recently described for catastrophic internal fixation failures. PFR is an attractive treatment option because it is technically straightforward and allows for immediate mobilization of the patient. The aim of the study was to determine the survivorship, functional outcome and complications’ rate in a group of elderly patients who underwent proximal femoral replacement as a salvage treatment after femur cephalomedullary nails’ mechanical failures. MethodsWe evaluated 21 patients who underwent salvage of a failed cephalomedullary nail by using a single design PFR at our institution between 2014-2017. A cemented stem was used in all cases. Radiographs were assessed for fractures, sign of loosening, presence of heterotopic ossification and leg length discrepancy. Functional evaluation was performed through Harris Hip Score (HHS), FIM™ and Time Up and Go test (TUG). Kaplan-Meier estimator was used to determine the overall implants’ survival. ResultsThe average age at the time of surgery was 83years. The mean follow-up was 3.1years. We recorded 3 dislocations of which 2 required a revision. No case of septic or aseptic failure was reported. Two patients died respectively at 11 and 14 months after surgery. At the last follow-up the mean HHS, FIM™, and the TUG improved significantly (p<0.05). ConclusionImmediate weight bearing, good functional outcomes, low complications’ and one-year mortality rate make the proximal femur replacement with megaprostheses a potential first line treatment of intertrochanteric/subtrochanteric fixations’ failures among elderly, osteoporotic, frail patients. Dislocation is the most common complication to bear in mind within the first six months after surgery.

Cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with femoral shaft fractures in Malawi

Background and purpose — In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of femoral shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST. Patients and methods — This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with femoral shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty. Results — Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66–0.76) and 0.77 (CI 0.71–0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer’s perspective, or $1,035 from the societal perspective. Interpretation — IMN was cost saving and more effective than ST in the treatment of adult femoral shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.

A Clinical Study on the Treatment of Multiple Radial Fractures with Embedded Wearable Device Holder and Absorption Bone Nail Combined with Decoction.

Multiple radial fractures have brought great pain to the patients, and the treatment takes a long time and the effect is slow, which seriously affects people's production and life. Traditional conservative treatment methods are mostly used for radius fractures. However, with the development of science and technology of the times, the level of medical treatment is also constantly improving. For radius fractures, the embedded wearable device fixation frame absorption bone nail treatment method has attracted attention. In order to study whether the embedded wearable device fixation frame can treat radius fractures, this article conducted a related survey of radius fracture patients in a hospital in a certain city, reviewed related literature, conducted interviews with professionals and so forth, and collected relevant information. A case template was constructed, and a clinical research model was created using a comprehensive quantitative and qualitative analysis method. The results of the study found that using the research embedded wearable device fixation frame to treat radius fractures with absorption bone nails can achieve good results, and its healing efficiency is about 20% faster than conservative treatment. With decoction, its treatment efficiency can be improved; and the prognostic treatment of the decoction can reduce the complications of the patient's treatment by about 13%. This shows that the embedded wearable device holder absorption bone nail combined with decoction can play an important role in the treatment of multiple radius fractures.

Pilot Study of the Efficacy and Safety of Nail Gel Containing Artemisia abrotanum Extract and Glycerin in the Treatment of Nail Plate Surface Abnormality

Background: Nail gels are utilized for the treatment of nails for nail plate surface abnormalities. However, the objective measurement of nail gel treatment is limited.&#x0D; Objective: This study investigated the efficacy and safety of a nail gel containing glycerin and Artemisia abrotanum extract in treating nail plate surface abnormalities.&#x0D; Material and Methods: All nails were evaluated with a Visiometer® system and by transonychial water loss (TOWL) at baseline, and at the 2nd and 8th weeks of treatment.&#x0D; Results: In total, 19 patients with a mean age of 50.6 years old were enrolled and 50 nails were studied. Sixty percent of the patients showed significant clinical improvement, as determined by the total agreement between two treatment-blinded dermatologists. Regarding the Visiometer®, a significant reduction in the SER value (roughness) of the nail plates was found at the 2nd week, while at the 8th week, the surface and volume values had significantly decreased from baseline and also from the values at the 2nd week. There was a significant improvement in the Rku (smoothness) value at the 8th week compared to baseline. The mean TOWL at the 2nd and 8th weeks were statistically decreased from baseline. No side effects were detected.&#x0D; Conclusions: This nail gel containing Artemisia abrotanum extract provided benefits in restoring hydration and improving the nail barrier in patients with nail surface abnormalities.

Distinctions in the Management, Patient Impact, and Clinical Profiles of Pachyonychia Congenita Subtypes

Introduction: Pachyonychia congenita (PC) is a rare dermatosis that confers lifelong physical and emotional morbidities in affected patients. However, the clinical findings, treatments, and psychosocial impact of this disease have not been adequately described. The International PC Research Registry (IPCRR), a multinational initiative to collect data on PC patients, has allowed an opportunity to distinguish the salient features of this disease. We aimed to characterize the breadth and extent of nail disease, treatments, and quality of life in PC patients, and to describe any significant differences in clinical presentation or treatment of PC subtypes. Methods: The most recent IPCRR patient survey data consisting of an 857-response questionnaire and a 102-response addendum were analyzed in a retrospective analysis. The survey data were collected as part of a multinational, multicenter initiative and comprise the largest representative population of PC to date. Participants (survey respondents) were included in the study based on questionnaire responses and a genetic confirmation of having a PC subtype. Results: A total of 857 survey responses were collected. Genetic variations among PC subtypes influence nail disease onset and severity of symptoms. Nail disease negatively impacts patients’ emotional health, especially during the adolescent and young adult years. Nail treatment tools vary little in terms of effectiveness and acquired infection rates. Conclusion and Discussion: Patients with different PC subtypes have distinct clinical nail presentations and psychosocial impact. Genetic testing should be used to confirm PC diagnoses. Further characterization of PC, especially the rarer subtypes, may allow for more individualized patient education.

In vitro and in vivo antibacterial properties of peptide AMC-109 impregnated wound dressings and gels.

Synthetic mimics of antimicrobial peptides (AMPs) is a promising class of molecules for a variety of antimicrobial applications. Several hurdles must be passed before effective systemic infection therapies with AMPs can be achieved, but the path to effective topical treatment of skin, nail, and soft tissue infections appears less challenging to navigate. Skin and soft tissue infection is closely coupled to the emergence of antibiotic resistance and represents a major burden to the healthcare system. The present study evaluates the promising synthetic cationic AMP mimic, AMC-109, for treatment of skin infections in vivo. The compound is evaluated both in impregnated cotton wound dressings and in a gel formulation against skin infections caused by Staphylococcus aureus and methicillin resistant S. aureus. Both the ability to prevent colonization and formation of an infection, as well as eradicate an ongoing infection in vivo with a high bacterial load, were evaluated. The present work demonstrates that AMC-109 displays a significantly higher antibacterial activity with up to a seven-log reduction in bacterial loads compared to current clinical standard therapy; Altargo cream (1% retapamulin) and Fucidin cream (2% fusidic acid) in the in vivo wound models. It is thus concluded that AMC-109 represents a promising entry in the development of new and effective remedies for various skin infections.

Management of fracture both bones forearm with plating/medullary nailing: A comparative study

Introduction: Fracture of both bones forearm in adults occupy a large field of modern traumatology. Maintenance of radial bow, regaining length, good apposition and alignment without malrotation is essential to restore good range of motion of forearm. Aim: to compare functional and radiographic results of plate osteosynthesis to IM nailing in treatment of diaphyseal forearm fracture in adults.Method: A prospective study comprising of 32 patients. 16 patients treated with open reduction and internal fixation using 3.5 mm DCP and 16 patients by IM nailing using 316L SS Talwarkar square nailing by closed or mini open reduction.Result: Mean age of patients was 36.4 years (range 20 to 58 years), Maximum number of patients in this study are middle age group and mean age is 48 years most fractures were of type 22A3 as per AO/OTA classification. Average operative time was 83 minutes and 64 minutes in plating and nailing respectively. Out of 16 patients in each group in our present study we encountered complications like restriction of movements at elbow in 5 (31.25%) plating cases and 3 (18.75%) nailing cases; restriction of movements at wrist in 1(6.25%) plating case and 0 nailing cases and loss of supination or pronation or both were observed in 6 (37.5%) each in nailing and plating cases. Localised bursitis were observed in 2 (12.5) nailing cases alone & wound healing and superficial infections were observed in 2 (6.25%) plating cases alone. We had 1 (6.25%) Non-Union is case of Plating and all fractures united in cases operated with nailing. Out of the 32 sample cases, taking into the account of our functional grading we have observed that about 9 (56.25%) cases have been graded with excellent outcome in plating group and 10 (62.5%) in nailing group, similarly about 5 (31.25%) have been graded with good outcome in plating and 3 (18.75%) in nailing group respectively and satisfactory outcome in 1 (6.25%) in plating group and 3 (18.75%) in nailing group. This has been only 1 (6.25%) case which had a Poor outcome in plating group in our study.Conclusion: We conclude that open reduction and internal fixation with dynamic compression plating is gold standard for treating diaphyseal forearm fracture in adults as it provides rigid fixation, restores forearm stability earlier and has negligible complications.

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly.

BackgroundProximal humeral fractures (PHFs) account for 4–5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients.MethodsA total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared.ResultsNo differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02).ConclusionsMultiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

Treatment of hook nails using the Bakhach’s technique: a retrospective study

INTRODUCTION: The cause of the hook nail is the trauma of the hyponychium. The nail plate presents longitudinal hypercurvature of volar concavity, causing functional loss, aesthetics concerns, and pain. OBJECTIVE: To evaluate the research results of 20 medical records of patients submitted to hook nail correction surgeries of traumatic etiologies. METHODS: Epidemiological, cross-sectional, retrospective study of patients’ medical records who were submitted to Bakhach’s surgical technique, from 2010 to 2018, in the Hand Surgery Outpatient Clinic of the Hospital do Servidor Público Municipal de São Paulo. RESULTS: We analyzed 20 affected fingers: 7 were victims of accidents with sharp objects, 5 with press machines, 5 with doors, 1 with window, 1 with motorcycle, and 1 due to a dog bite. The finger with the highest incidence was the middle finger (n=12), followed by the index finger (n=5), and ring finger (n=3). The main complaint was aesthetics (n=11); pain (n=6), and functional (n=3). All cases had type II distal digital transverse amputations and underwent surgical treatment. The reconstruction surgery occurred between 4 and 25 months after the trauma. CONCLUSION: 15 patients were satisfied and two felt pain: one in the distal interphalangeal joint and the other in the hyponychium. The follow-up ranged from 6 months to 2 years.

Our experience of Tsume-pla for the treatment of incurvated nails of great toe

Our experience of Tsume-pla for the treatment of incurvated nails of great toe

Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis.

Recently, several studies have suggested that blade-type cephalomedullary nails (CMNs) have a higher risk of fixation failure than that of lag screws, but no clinical consensus exists. This study compared fixation failure between helical blade-type and lag screw-type CMNs with cut-out and cut-through rates as primary outcomes and degree of sliding length, time to union, and nonunion rate as secondary outcomes. MEDLINE, Embase, and Cochrane Library were systematically searched for studies published before March 4, 2020, using the PRISMA guidelines. Studies were included if they directly compared helical blade and lag screw for treating hip fractures. Data could be extracted for CMN alone to avoid mixing CMN and extramedullary plate devices, such as the dynamic hip screw. Two board-certified orthopaedic surgeons specializing in hip surgery independently extracted data from the selected studies, and the data collected were compared to verify agreement. All data were pooled using a random-effects model. For all comparisons, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, whereas continuous data were analyzed using mean differences with 95% CIs. Fixation failure (OR = 1.88, 95% CI: 1.09-3.23, P = 0.02), especially cut-through (OR = 5.33; 95% CI, 2.09-13.56; P < 0.01), was more common with helical blades than with lag screws, although the cut-out rate was not significantly different between both the 2 groups (OR = 0.87, 95% CI: 0.38-1.96, P = 0.73). Surgeons should carefully select a blade-type CMN when treating hip fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

14161 Ixekizumab is superior to placebo for the treatment of nail, scalp, and palmoplantar psoriasis in pediatric patients with moderate to severe plaque psoriasis

Introduction: Ixekizumab is approved for moderate to severe plaque psoriasis in adults. We report efficacy of ixekizumab for nail, scalp, and palmoplantar psoriasis, and patient-reported psoriasis severity from IXORA-PEDS (NCT03073200), investigating efficacy and safety of ixekizumab in pediatric patients with moderate to severe plaque psoriasis.

A Comparative Study of Intramedullary Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis for Type A Tibial Fracture Healing

Objective This study aimed to retrospectively compare the efficacy of intramedullary nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the fracture healing of patients with type A tibial fractures. Methods Patients who had been diagnosed with type A tibial fracture (AO classification method) and treated with minimally invasive surgery in our hospital from January 2016 to January 2019 were included in the study. There were 21 patients in the MIPPO group and 27 patients in the intramedullary nailing group. The operation time, intraoperative blood loss, surgical incision length, callus formation time, and fracture healing time of the two groups were analyzed and compared. Results In the intramedullary nailing group, the callus formation time and the fracture healing time were shorter than those in the MIPPO group (P&lt;0.005). Their operation time, intraoperative blood loss, and the surgical incision length were comparable between the two groups. Conclusions For patients with type A tibial fracture and poor wound tissue conditions, intramedullary nailing fixation treatment may be a better choice than MIPPO. Because in patients receiving intramedullary nailing treatment, the callus formation time and fracture healing time are short, and functional exercises can be performed soon after the surgery, which can reduce the occurrence of related complications.

Comparison of clinical, radiological, and functional outcome of closed fracture of distal third tibia treated with nailing and plate osteosynthesis

Aim: This is a prospective study of 30 patients with distal tibia fracture (Closed extra-articular distalthird tibia fractures - 4 to 11cm from tibial plafond) who underwent surgical fixation were included inthis study after excluding compound, pathological and pediatric fractures. Materials and Methods:15 underwent closed intramedullary interlocking nail and 15 were treated with plate osteosynthesis(MIPO). Results: The age distribution ranged from 23 to 68 years with the mean age of 39.4 years.The mode of injury in all patients was due to vehicle accidents. All 30 patients were classifiedaccording to AO classification of which 15 belonged to A1, 14 belonged to A2, and 1 belonged to A3.The time of fixation from injury varied from 6 hours to 18 days. Conclusion: Plate osteosynthesisby minimally invasive technique and Intramedullary interlocking nailing is an equally effectivemethod of stabilization for distal tibia fracture when considering the union rates and final functionaloutcome. However, malunion, nonunion and secondary procedures were more frequent afterintramedullary interlocking nail. In MIPO platting Infection followed by an exposed plate occurs in 2patients. Randomized prospective evaluation of distal tibia fractures may clarify the efficacy of plateversus nail treatment and optimize patient care.