A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures

Abstract

Background:Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO).Materials and Methods:42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation.Results:In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant (P < 0.0001). Average time required for partial and full weight bearing in the nailing group was 4.95 weeks and 10.09 weeks respectively which was significantly less (P < 0.0001) as compared to 6.90 weeks and 13.38 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67.Conclusion:IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

Comparison of 3 Treatment Methods for Distal Tibial Fractures: A Network Meta-Analysis

“…However, Vallier et al reported that there was no significant difference between IMN and locking plates in terms of nonunion rate, and IMN had a high rate of malalignment [35]. Other studies found similar effects between IMN and plates [29,37]. Our results are consistent with these.…”

“…The SUCRA probabilities were 55.1% for ORIF, 43.2% for IMN, and 51.7% for MIPPO (Figure 7A). Delayed union was reported in 7 trials [12,29,31–33,35,37]. No significant differences were found in the incidences of delayed union of IMN, ORIF, and MIPPO (ORIF: RR=1.34; 95% CI, 0.4–3.87; P=0.594; MIPPO: RR=0.72; 95% CI, 0.35–1.72; P=0.377; Figure 6B).…”

“…A total of 908 potential studies were identified by the search method; 157 duplicate studies were eliminated, 683 studies were eliminated by reading titles and abstracts, and 68 studies were screened for relevance according to full text. Finally, 11 studies with 710 participants were included [7,12,29–37]. Three types of internal fixations, including IMN, MIPPO, and ORIF, were used in these 11 trials.…”

“…The SUCRA probabilities were 20% for ORIF, 44.6% for IMN, and 85.4% for MIPPO (Figure 7B). Infection was reported in all 11 included RCTs [7,12,29–37]. There was a significant difference between IMN and MIPPO in terms of infection rate.…”

Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

“…Six studies were conducted in India [9, 10, 18–20], three in China [23, 26, 28], one in the UK [21], and one in Turkey [25] and the USA [24]. Nine studies [9, 10, 18–21, 25, 27] focused on closed or Gustilo patients and most of the studies [10, 19–21, 23–27] followed up participants for more than 12 months. Most of the studies reported the time to reunion of the tibia, except three studies [9, 10, 21].…”