DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20221622
Published: 2022-06-24

A prospective comparative study of functional outcome of distal extra articular tibia fracture fixed with intramedullary nail versus locking compression plate

T. H. Prakashappa, Madhusudan B., Bharath M. C., Nagaraju H., Ashwin S.

Abstract


Background: Distal tibia fractures are one of the most common long bone fractures and their management presents with a series of problems due to the soft tissue surroundings and even more at risk due to their proximity to ankle joint. In our paper we showed functional outcome of distal extra articular tibia fracture while comparing its management between intramedullary nailing and locking compression plate.

Methods: There were 40 patients from November 2019 to November 2020 with distal extra articular tibia fracture. Patients were divided into 2 groups, first group included 20 patients managed with intramedullary nail and the second group included 20 patients managed with locking compression plate. Patients were followed preoperatively, intraoperatively and postoperatively for functional outcome and assessed clinically using AOFAS score and radiologically using X-ray.

Results: Out of the 40 cases treated in this manner, all cases were available for the follow up for a period of 1 year. Overall results by 1 year follow up showed excellent in 7 cases (35%) good in 13 cases (65%) in nailing group and in plating group showed excellent in 4 cases (20%), good in 12 cases (60%), fair in 3 cases (15%) and poor in 1 case (5%).

Conclusions: All fractures united well. Complications were encountered in 4 patients, 2 patients had superficial wound infections,1 patient had deep infection and another had persistent ankle pain in plating group and 2 patients had superficial wound infection in nailing group. No cases showed malunion or nonunion in both plating as well as nailing group.


Keywords


Distal extra articular tibia fracture, Locking compression plate, Intramedullary nail

Full Text:

PDF

References


Fan CY, Chiang CC, Chuang TY, Chiu FY, Chen TH. Interlocking nails for displaced metaphyseal fractures of the distal tibia. Injury. 2005;36:669-74.

Ovadia DN, Beals RK. Fractures of the tibial plafond. J.Bone Joint Surg Am. 1986;68, 543-51.

Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Verlag Berlin Heidelberg Springer Verlag Berlin Heidelberg. 1990.

Sarmiento A, Latta LL. 450 closed fractures of the distal third of the tibia treated with a functional brace. Clinical orthopaedics and related research. 2004;(428):261-71.

James FKLA. AO Principles of fracture management 2nd ed. Thomas PR RE, Christopher GM, ed, editor: Thomas PR, Richard EB, Christopher GM, ed. 2007.

MV N. Textbook of orthopedics and traumatology. 7th ed: Wolter kulwer health (India). 2011.

Court-Brown CM< Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br 1990;72:605-11.

Williams TM. External fixation of tibial plafond fractures: is routine plating of the fibula necessary? J Orthop Trauma. 1998;12:16-20.

Dogra AS, Ruiz AL, Thompson NS, Nolan PC. Dia-metaphyseal distal tibial fractures--treatment with a shortened intramedullary nail: a review of 15 cases. Injury. 2000;31:799-804.

Nork SE. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213-21.

Egol KA. Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma. 2006;20:94-103.

Duckworth AD, Jefferies JG. Type C tibial pilon fractures: short- and long-term outcome following operative intervention. Bone Joint J. 2016;98-B(8):1106-11.

Kumar A, Charlebois SJ, Cain EL. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.

Hong. Posteromedial anatomical plate for the treatment of distal t ibial fractures with anterior soft tissue injury. Orthopedics. 2011;34(6):161.

Blick, Ray A, Stern R. The extensile approach for the operative treatment of highenergy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma. 2007;21(3):198-206.

Koval KJ, Lurie J, Zhou W, Sparks MB, Cantu RV, Sporer SM, et al. Ankle fractures in the elderly: What you get depends on where you live and who you see. J Orthop Trauma. 2005;19(9):635-9.

Kumar A, Charlebois SJ, Cain EL. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.

Bhat R1, Wani MM, Rashid S, Akhter N. Minimally invasive percutaneous plate osteosynthesis for closed distal tibial fractures: a consecutive study based on 25 patients.Eur J Orthop Surg Traumatol. 2015;25(3):563-8.

Sönmez MM, Gülabi D. Minimal invasive fixation of distal tibial fractures does not result in rotational malalignment: A report of 24 cases with CT imaging.Ulus Travma Acil Cerrahi Derg. 2017;23(2):144-9.

Bisaccia M. Management of distal extra articular tibia fracture “between 2009-2015 on 81 patients.

Guo JJ, Tang N, Yang HL, Tang TS. Aprospective, randomized trial comparing closed intramedullary nailing with percutaneous plating in treatment of distal metaphyseal fractures of tibia. J Bone Joint Surg Br. 2010;92-B:984-8.

Ayeni JP. Pilon fractures of the tibia: a study based on 19 cases. Injury. 1988;19(2):109-14.