Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2)

Abstract

ObjectiveThe aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2).MethodsSeventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group.ResultsFunctional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000).ConclusionSimple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern.Level of EvidenceLevel III, Therapeutic Study.

Two Stage Minimally Invasive Method with Locking Plate Application on Distal Tibia Fractures - Our Experience

“…The second important moment in the distal tibia fracture treatment also refers to soft tissue protection. All techniques that spare the soft tissue above the fracture, such as external fixation, intramedullary fixation[ 11 ], minimally invasive approach, should be preferred to the open surgical approach for treating distal tibia fracture due to the specificities of the rigid soft-tissue envelope of distal tibia [ 3 , 12 , 13 ].…”

“…The application of the minimally invasive approach in cases of postponed definitive intervention and pre-shaped anatomical locking plate application with internal fixation, theoretically and practically leads to drastic improvement of the quality of life and reduction of the disability of patients with intra-articular distal tibia fracture [ 1 , 3 , 9 - 11 ].…”

Early Results of Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of the Distal Tibia: A Retrospective Case Series and Review of the Literature

“…This needs to be taken into consideration when making a choice of treatment method, and the patients need to be well informed about these complications. In an attempt to elucidate this concern, the same author reported his comparative findings in another paper 35 where they used MIPO in one group of patients and intramedullary nailing in another but similar group of patients. They conceded that MIPO is the first preference according to the literature.…”

Comparison of surgical treatment methods in patients with closed tibia pilon fractures: A systematic review and meta-analysis of clinical and functional outcomes

“…Only few studies have investigated the treatment of simple tibial pilon fractures with IMN [63][64][65] . Marcus et al [63] reported low complication rates but emphasized in the need for high level of experience to produce great results.…”