DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171851

Osteosynthesis distal tibial metadiaphyseal fractures with intramedullary nailing versus plating

Deepak Vashisht, Manjit S. Daroch, Sanjeev Sreen, Kuldeep Rathi

Abstract


Background: The management of the tibial fracture remains controversial despite advances in both non-operative and operative care. Plates and intramedullary nails are two well-accepted and effective methods, but each has been historically related to complications. The present study was conducted to compare the results of displaced extra-articular distal tibia meta-diaphyseal fractures OTA/AO Type 42A- C (distal) and 43-A treated with intramedullary nailing versus plating with respect to union of fracture, early Restoration of function, the axial alignment and Complications, if any.

Methods: In this study 30 patients of extra-articular distal tibia fracture AO type 42 A-C (distal) and 43 A were randomly selected and 15 were operated with intramedullary nailing and remaining 15 with plating. The patients were regularly followed up for a period of 9 months with radiological and clinical examination. Final assessment was done by Tenny and Wiss clinical assessment criteria.

Results: In Interlocking group, average time for union was 20.33 weeks in Interlocking nail group compared to 23.21 weeks in plating group which was significant (p value 0.011). Also, the average time required for partial and full weight bearing in the nailing group was 7.2 weeks and 13.2 weeks respectively which was significantly less as compared to 9.33 weeks and 16.64 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in Interlocking group as compared to plating group.

Conclusions: In present study ILN showed better outcome as it offers advantage in terms of mean operating time, less invasive surgery, hospital stay, partial and full weight bearing time and union time.


Keywords


Distal tibia metadiaphyseal fractures, Expert tibia nailing, Intramedullary nailing, Plating

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References


Pawar ED, Agrawal SR, Patil AW, Choudhary S, Asadi G. A Comparative Study of Intramedullary Interlocking Nail and Locking Plate Fixation in the Management of Extra Articular Distal Tibial Fractures. J Evol Medical Dental Sci. 2014;3(24):6812-26.

Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77(3):417-21.

Obulapathy D, Reddy S. Management of distal third fractures of tibia by plating or interlocking nailing: a comparative study. Inter J Recent Scie Res. 2015;6(6):4918-20.

Matejčić A, Mihovil I, Tomljenović M, Krolo I. Forearm shaft fractures: results of ten-year follow-up. Acta Clinica Croatica. 2000;39(3):147-53.

Watson-Jones R, Coltart WD. Slow union of fractures: with a study of 804 fractures of the shafts of the tibia and femur. Br J Surg. 1943;130:260-76.

Dehne E, Metz CW, Deffer P, Hall R. Nonoperative treatment of the fractured tibia by immediate weight bearing. J Trauma Acute Care Surg. 1961;1(5):514-35.

Schatzker J, Tile M, Axelrod TS. The rationale of operative fracture care. Springer; 2005:477.

Rockwood CA, Green DP. Fractures in adults, Philadelphia. J.B. Lippincott Co., Ed. 8, Vol.2: 2428.

Allgower M. A healing of clinical fractures of the tibia and rigid internal fixation. Reprint from “The healing of osseous tissue. Natl Acad Sci, Natl Res Council. 1967:81-9.

Duda GN, Mandruzzato F, Heller M, Goldhahn J, Moser R, Hehli M, et al. Mechanical boundary condition of fracture healing: borderline indications in the treatment of undreamed tibia nailing. J Biomech. 2001;34:639-50.

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25(12):736-41.

Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y et al. Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012;36(7):1457-62.

Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-8.

Li B, Yang Y, Jiang LS. Plate fixation versus intramedullary nailing for displaced extra-articular distal tibia fractures: a system review. Eur J OrthopSurgTraumatol. 2015;25(1):53-63.

Vallier HA, Le TT, Bedi A. Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing. J Orthopaedic Trauma: May/June 2008;22(5):307-11.

Yip WH, Lee KB, Shen WY. Early Experience of Metaphyseal Plating by the Minimally Invasive Plate Osteosynthesis Technique for Closed Distal Tibial Fractures. Hong Kong J Orthop Surg. 2006;10(1):22-7.

Hegazy G; Rashed R E ; Elfatah Al-sha E A, Hassan A E. Biological fixation of Distal Tibial Fractures by locking compression plate. J Am Sci. 2015;11(5):179-84.

Neer CS. Injuries to the acromioclavicular joint. In: Rockwood CA Jr, Green DP, eds. Fractures in Adults. Vol 1. 2 nd ed. Philadelphia, PA: JB Lippincott; 1984:895.