Hindfoot Alignment Changes after Internal Fixation of Distal Tibial Fracture: Comparing Radiological and Clinical Outcomes of Patients Treated with Standard Plating vs Intramedullary Nailing

Abstract

Category: Trauma Introduction/Purpose: Until now, many papers Traditionally concerned for union of the fracture, changes of alignment, clinical symptoms and complication. However, there are no studies on changes in foot alignment, hid foot and related clinical changes. The Purpose of this study to evaluate clinical outcome and radiological outcome including hind foot alignment using Plate versus IM nail fixation of distal tibia fracture and to evaluate influence factors of hindfoot alignment alteration among the radiologic parameters. Methods: Overall, 92 patients with distal tibial metaphyseal fractures (AO-OTA 43-A1, 43-A2) with simple or no articular involvement treated from 2002 to 2013. Among them, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Inclusion criteria were applied for patient group. Union rate and complication rate compared both group. Radiographic measurements were evaluated at a minimum of 1-year follow-up. Radiological parameters of hindfoot angulation and moment arm were measured at the Saltzman view, calcaneal pitch angle and Meary angle were measured at the lateral standing radiograph. Hindfoot alignment changes after surgery were compared between both groups using student T-test. Alignment changes after fracture site union were evaluated simple radiograph and computed radiograph; coronal plane angulation, saggital plane angulation and transverse plane rotation were measured. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment Results: We studied 92 patients with distal tibia fractures treated with IMN (39 patients) and SP (53 patients). 37 patients in the IMN group and 47 in the IMN group met inclusion criteria. All patients ultimately healed, with the average time to union of 26 weeks in both the groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch and Mearly angles showed no difference between the groups. But moment arm was increased valgus in the IMN group. Angulation at fracture site on the coronal and hindfoot alignment changes were showed low significant relationship(R=0.38). But transverse rotation and hindfoot alignment changes were showed high significant relationship(R=0.79). And only transverse rotation has a strong correlation with hindfoot alignment changes after regression analysis. Conclusion: Similar union rate and complication were seen when treating nonarticular metaphyseal distal tibia fractures with SP compared with IMN. Angulation on coronal plane after internal fixation may a little affect to change hindfoot alignment due to compensation on the subtalar joint. However, rotation on the transverse plane has intactly influenced hindfoot alignment alteration. Therefore, regardless of the fixed method, the patients treated distal tibial fracture required close attention to changes in hindfoot alignment due to transverse rotation during surgery.