Treatment of distal tibia fractures: plating versus intramedullary nailing

Abstract

<p class="abstract"><strong>Background:</strong> Distal tibia shaft fractures pose significant challenge to treating surgeons. Giving more importance to anatomical reduction and ignoring often injured soft tissues has led to poor outcomes and high complication rates. Although multiple options are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to study the results of distal tibia fractures treated by expert tibia nailing and distal tibia plating.</p><p class="abstract"><strong>Methods:</strong> This study was undertaken in patients who were operated in between January 2012 to March 2015 at M S Ramaiah Teaching Hospital, which is a tertiary care hospital in Bangalore. Study included 52 patients with distal tibia fracture treated by surgery. All the fractures were closed distal diaphyseal fractures without articular involvement. Thirty two patients underwent expert tibia nailing whereas 20 patients were treated with open reduction and internal fixation with locking plates. Patients were followed up at 6 weeks, 3 months, 6 months and 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Fifty two patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 20 patients whereas nailing group included 32 patients. The mode of injury was road traffic injury in 32 cases , followed by self-fall in 17 cases and sports related injury in 3 cases. Distal tibia fracture was associated with in 29 patients (87%) of nailing group whereas in 17 patients (80) of plating group. Average distance of fracture from pilon was 6 cm in nailing group and 3cm in plating group. The average duration of surgery in nailing was group was 88 minutes (range, 65-130 minutes) whereas average duration of surgery in plating group was group was 92 minutes (range, 70-130 minutes). The average time for union was 16 weeks for nailing group and for plating group it was 18 weeks. </p><p class="abstract"><strong>Conclusions:</strong> Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to pilon whereas intramedullary nailing is preferred for fractures away from tibial pilon. There is no significant difference between union and complication rates.</p>

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