Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial

Abstract

BackgroundExtra-articular proximal tibial fractures account for 5–11 % of all tibial shaft fractures. In recent years, closed reduction and minimally invasive plating and multidirectional locked intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures.Materials and methodsThis randomized prospective clinical study was conducted on 58 skeletally mature patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive proximal tibial plating (PTP) or intramedullary nailing (IMN) by trained surgeons at a tertiary trauma center.ResultsPostoperative hospital stay (p = 0.035), time to full weight-bearing, and union time (p = 0.004) were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time (p = 0.082), infection rate (p = 0.738), range of motion of the knee (p = 0.462), or degrees of malunion and nonunion.ConclusionBoth implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse.Level of evidenceLevel 2, randomized controlled trial.

A prospective study of outcomes of intramedullary nailing of proximal third shaft tibia fractures

“…#Union Min Max Mean Rate % p-value wrt present VIDYADHARA S et al [1] 12 36 17.2 0.1626 LINDVALL E et al [16] 96 MEENA RC et al [2] 10 30 18.26 94.7 0.1809 PRESENT 12 18 Pain: Present study reported moderate Knee Pain in 7 cases.…”

“…After the end of 6 months follow up most of the patients showed excellent results (12patients, 60%), 5 patients (25%) falls under good category, 3 patients (15%) showed fair results and none of patient showed poor results. [1] 18 67 43 Nork Se et al [15] 19 73 42 Lindvall E et al [16] 18 60 36.41 Meena Rc et al [2] 18 65 39 Present 19 60 33.6…”

“…Closed I II IIIA IIIB IIIC Total Chi Sq wrt present p-value wrt present VIDYADHARA S et al [1] 18 7 8 12 0 0 45 6.78 0.079 NORK SE et al [15] 22 [2] Hospital Stay(Days) Minimum Maximum Mean MEENA RC et al [2] 2 9 Fracture union The average time for fracture union in various studies conducted using various methods was 10-36 weeks. Our study had fracture union at 12-18 weeks which were comparable with studies.…”

“…Infection None SSI Deep NORK SE et al [15] 35 0 2 LINDVALL E et al [16] 17 5 0 MEENA RC et al [2] 19 0 0 PRESENT 14 3 3 Malalignment: Malalignmen with Valgus and Apex Anterior were Seen Commonly and is comparable.…”

“…Among the total tibial fractures, about 5-11% of fractures occur in the proximal one third of the tibia [1,2] Proximal tibial fractures are caused most commonly due to high energy trauma like road traffic accidents, Fall from Height, Assault and also due to pathological causes like tuberculosis of bone, staphylococcal infections etc. Treatment is more challenging than for more distal fractures, and the rates of compartment syndrome and arterial injury are higher, especially for displaced fractures.…”