Treatment of distal tibia fractures: plating versus intramedullary nailing

Background: Distal tibia shaft fractures pose significant challenge to treating surgeons. Giving more importance to anatomical reduction and ignoring often injured soft tissues has led to poor outcomes and high complication rates. Although multiple options are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to study the results of distal tibia fractures treated by expert tibia nailing and distal tibia plating.Methods: This study was undertaken in patients who were operated in between January 2012 to March 2015 at M S Ramaiah Teaching Hospital, which is a tertiary care hospital in Bangalore. Study included 52 patients with distal tibia fracture treated by surgery. All the fractures were closed distal diaphyseal fractures without articular involvement. Thirty two patients underwent expert tibia nailing whereas 20 patients were treated with open reduction and internal fixation with locking plates. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year.Results: Fifty two patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 20 patients whereas nailing group included 32 patients. The mode of injury was road traffic injury in 32 cases , followed by self-fall in 17 cases and sports related injury in 3 cases. Distal tibia fracture was associated with in 29 patients (87%) of nailing group whereas in 17 patients (80) of plating group. Average distance of fracture from pilon was 6 cm in nailing group and 3cm in plating group. The average duration of surgery in nailing was group was 88 minutes (range, 65-130 minutes) whereas average duration of surgery in plating group was group was 92 minutes (range, 70-130 minutes). The average time for union was 16 weeks for nailing group and for plating group it was 18 weeks. Conclusions: Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to pilon whereas intramedullary nailing is preferred for fractures away from tibial pilon. There is no significant difference between union and complication rates.

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Comparative Study between Intra-medullary Nailing and Minimally Invasive Plate Osteosynthesis (MIPO) in Closed Distal Tibia Fracture in a District Hospital in Bangladesh

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v12i1.51616 ◽

2021 ◽

Vol 12 (1) ◽

pp. 33-37

Author(s):

Md Asjadur Rahman ◽

Md Shahidullah Kaiser ◽

SM Roknuzzaman ◽

Nadim Ahmed

Keyword(s):

Intramedullary Nailing ◽

Weight Bearing ◽

Distal Tibia ◽

Tibia Fracture ◽

Tibial Fractures ◽

Distal Tibia Fracture ◽

Significant Difference ◽

Duration Of Surgery ◽

Tibia Fractures ◽

Distal Tibia Fractures

Introduction: Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPO technique. Methods: The study was conducted between Jan 2018 to Dec 2019. 30 patients with extraarticular distal tibia fracture treated with intramedullary nailing and MIPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results: 15 patients were treated with intramedullary nail and 15 with MIPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPO group. Conclusion: Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures and helps in early weight bearing and ambulation of patient with fewer complications. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 33-37

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Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.09.004 ◽

2018 ◽

Vol 24 (1) ◽

pp. 66-71

Author(s):

Kawalkar Abhijit Chandrakant ◽

Badole Chandrashekher Martand

Keyword(s):

Intramedullary Nailing ◽

Weight Bearing ◽

Distal Tibia ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Early Weight Bearing ◽

Significant Difference ◽

Duration Of Surgery ◽

Tibia Fractures ◽

Distal Tibia Fractures

Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.

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