Prospective comparative study of extra-articular distal tibia fractures-intramedullary nailing versus medial minimally invasive percutaneous plating

Abstract

<p class="abstract"><strong>Background:</strong> The distal tibia extra-articular fractures are treated with both intramedullary nailing (IMN) and medial minimally invasive percutaneous plate osteosynthesis (MIPPO). The aim of this study was to compare the results of IMN and medial MIPPO in distal tibia fractures. The complications and secondary interventions in both groups were compared.</p><p class="abstract"><strong>Methods:</strong> Fifty patients with distal tibia were randomly assigned to IMN (group 1) and medial MIPPO group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average union time was 21.12±6.93 weeks in group 1 and 23.56±6.96 weeks in group 2 (p=0.220). The mean AOFAS scoring was 90.76±7.9 in group 1 and 88.4±8.33 in group 2 (p=0.339). Five patients in group 1 and one in group 2 had malalignment. Deep infection was present in one and superficial infection was present in two cases in group 2. None of the patients in group 1 had infections. Three patients in group I developed anterior knee pain and six in group 2 had hardware prominence. Seven cases in IMN group required secondary interventions and fourteen in medial MIPPO group.</p><p class="abstract"><strong>Conclusions:</strong> Extra-articular distal tibia fractures are successfully treated with IMN and medial MIPPO with comparable functional outcomes. Prevalence of malunion was higher in IMN group and hardware prominence was more prevalent in MIPPO group. Implant removal are more in medial MIPPO group mostly due to implant irritation.</p><p class="abstract"> </p>

Retrospective analysis of minimal invasive plating versus intramedullary nailing for treatment of extra-articular distal tibia fracture

“…20 In our study, the average period of radiological union was found to be 23.9 weeks for the plating group and 24 weeks among the nailing group. Our results were not statistically significant for the union time between the two groups as similarly shown in multiple studies done by Kumar et al, Lakhotia et al, Janssen et al, Bisaccia et al and Barcak et al 19,13,[22][23][24] However there are some studies like Guo et al and Pawar et al which showed shorter union time in IMILN group. 20,25 In our series, fibula fixation was performed in 27 cases out of 40 (17/23 MIPPO, 10/17 IMILN).…”

“…Malalignment was defined as a varus or valgus of more than 5 degrees in the coronal plane and procurvatum or recurvatum greater than 10 degrees in the sagittal plane. 13 Delayed union and non-union were defined as a failure of fracture union after six and nine months of surgery respectively. Any complication during the surgery and follow-up period was recorded.…”

Comparative study of functional outcome of distal one-third shaft tibia fractures treated with tip locking tibia nailing versus precontoured anatomical locking plate

“…The road traffic accident was the major mode of injury in both groups causing distal 1/3 rd shaft of diaphysio-metaphyseal fractures of tibia. Fracture type was based on AO fracture classification-12 cases classified to 42A (11 in TLIMN group and 1 in PCALP), 13 [5][6][7][8] Thus, both the study and groups were comparable in terms of age wise distribution of the patients. Thus, we concluded that distal 1/3 rd shaft tibia fractures are more common in middle age.…”

“…Modern tibial nail designs like tip locking tibia nail or expert tibia nail have interlocking holes that enable distal placement of screws in close proximity to tip of nail have solved issue of stability and alignment to a greater extent. 5 The closed intramedullary nailing also has been associated with significantly shorter operative time and fewer wound infection (AO/ASIF). 2 Locking compression plate (LCP) of tibial fractures was first described in the 1880's by Hansmann in Germany.…”

“…While the nailing group had two mal-unions, the plating group had one implant irritation and one superficial infection. Lakhotia et al5 with respect to secondary procedures to achieve union in nailing group one case had to dynamized and bone grafting was done in 2 cases (8%) where in one with delayed union and one with non-union 5. Ankle dorsiflexion and plantarflexion in tip locking IM nailing group was marginally better but statistically insignificant in comparison to PCALP group, as early mobilization was kept a target in both groups allowing early callus formation and early regain of functions.…”