Comparison of clinical and functional outcomes between intramedullary nailing and minimally invasive locking plates for closed extra-articular distal tibial fractures

Abstract

Background: Tibia is the main weight-bearing bone of the leg and accounts for 8-10% of lower limb fractures. Distal tibia fractures are prone to complications due to their subcutaneous nature. It is essential to preserve soft tissue and blood supply in this region to achieve good healing. Controversy exists with regard to use of intramedullary nailing (IMN) or minimal invasive locking plate for management. Aim: This study aims to evaluate and compare clinical and functional outcome of IMN and MIPO in the management of extra-articular distal tibial fractures. Methods: A total of 56 patients with extra-articular distal tibia fracture (OA type 43A1, A2, and A3) admitted to the orthopedic department of our institute between October 2017 and September 2020 were included in the study. One group was treated with intramedullary nail and the second group was treated with minimally invasive locking compression plate. Clinical and functional outcomes in the two groups were evaluated and comparisons were made. Results: The results were interpreted using the Olerud–Molander score according to which excellent outcome was noted in eight patients, good outcome in 45 patients, and fair outcome in 2 patients. One patient in the plating group recorded poor result. Conclusions: Intramedullary interlocking nailing can be considered a very effective modality of treatment indicated for closed extra-articular distal tibial fractures, but is technically demanding. Plating on the other hand can deliver satisfactory results when local soft tissue status is good.

Keywords

• distal tibia fractures
• extra-articular
• intramedullary nailing
• minimally invasive percutaneous plate osteosynthesis
• olerud–molander ankle score