Comparison between intramedullary nailing and minimally invasive plate osteosynthesis for tibial shaft fractures

Abstract

Introduction: Intramedullary nailing (IMN) is currently considered the gold standard in the surgical treatment of tibial shaft fractures in adult patients. In this case-control comparative study, we aimed to compare the efficacy of minimally invasive plate osteosynthesis (MIPO) and IMN in treating tibial shaft fractures. Materials and methods:The clinical and radiological outcomes, such as a modified trauma scale, operation time, fracture healing, rate of re-operation, and complications such as malunion, nonunion, shortening, and infection were assessed between IMN and MIPO for the treatment of tibial shaft fractures. Results: Seventy-three skeletally mature patients who underwent IMN (group I) or MIPO (group M) for a closed extra-articular tibial shaft fracture (AO/OTA type 42) from June 2010 to May 2016 were retrospectively reviewed. The mean age was 51.16 (18~79) years, and the mean follow-up period was 22 (12~50) months. Bony union was achieved in all cases but one for each group -group I (35 cases) and group M (36 cases) (p > 0.05). Mean callus formation was observed in 12 (8 -16) weeks in both groups (p > 0.05).There was no significant difference in operative time, hospital stay, bone healing, and the rate of complications among the two groups (p > 0.05). There was also no postoperative difference in functional evaluation between the two methods (p > 0.05). Conclusions:No discrepancy was found in radiological and clinical outcomes between IMN and MIPO for tibial shaft fractures. It can be concluded that both IMN and MIPO are equally effective treatment modalities for tibial shaft fractures.

Repetitive brief ischemia accelerates tibial shaft fracture healing: a 5-years prospective preliminary clinical trial (PCT)

“…The excellentgood rate of Johner-Wruhs scores was 100% that meant the limb function recovered satisfactorily. Besides, RBI decreased the VAS scores compared with previous studies and the control group at postoperative 2 weeks [17][18][19][20]. There was no venous thrombosis of lower limbs and postoperative complication occurred in any of the patients in RBI group so we thought that RBI might be safety to patients, however, this conclusion was needed many large sample-size randomized controlled trials to prove.…”

“…The nonunion rate of tibia shaft fracture is about 14% that is much higher than the average nonunion rate of long-bone fracture [1][2][3]. As for reducing disruption of local blood supply, intramedullary nails have been wildly used in clinic at present [17][18][19]. Despite strict adherence to the guidelines, the healing time and nonunion rate of tibial shaft fractures are not decreased significantly [1][2][3].…”

Functional Outcome of Distal Third Tibia Fractures Treated with Minimally Invasive Plate Osteosynthesis

“…Usually, disunion and excessive pain in the knee region is observed in the case of nailing. The nailing treatment is only suitable for the fractures in the proximal region but beyond this line, this nailing method is more complicated [17][18][19] . The function of the ankle was assessed by the criteria of Merchant and Dietz.…”

A Review of Proximal Tibia Entry Points for Intramedullary Nailing and Validation of The Lateral Parapatellar Approach as Extra-articular

“…13 Reamed IMN has become the mainstay of treatment for most adult tibial shaft fractures due to minimal soft tissue dissection, good bone union rate, and early return to daily living. 14 Cast immobilization is appropriate for low-energy tibial fractures with minimal soft tissue dissection; however, fractures with higher energy mechanisms involving more osseous and soft tissue disruption make closed reduction difficult to obtain and maintain. 13,15 In a study of 201 tibial shaft fracture cases, Puno et al reported IMN resulted in lower complication rates with one nonunion (1.7%), two infections (3.3%), and no malunions in 60 patients compared to closed reduction and casting, which resulted in 14 delayed unions or nonunions (9.9%), two infections (1.4%), and six malunions (4.3%) in 141 patients.…”