Comparison of Outcome of Locking Plate Fixation and Closed Intermedullary Interlocking Nail in the Management of Extra-articular Distal Tibial fractures

  • Medisetty Vinod Kumar Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India
Keywords: Distal tibia fracture,, Inter locking nail,, Locking plate,, Weight bearing

Abstract

Background: Distal tibia fractures are the second highest incidence in tibia fractures. Management of distal tibia fracture is most
challenging due its superficial nature and propinquity to the ankle joint. Hence, two different techniques were used to treat such
fractures.
Methods: Out of 26 patients, 13 were operated with interlocking nail (ILN) and 13 with locking plate fixation, patients were regularly
followed up to 1 year postoperatively, assessed clinically and radio-logically to rule out any complication and treated the same.
Results: Duration of surgery 40–60 min in 9 (69.2%) ILN, 5 (38.4%) plating 61–80 min in 4 (30.7%) ILN, and 5 (38.4%) in plating
>80 min observed in 3 (23%) only plating patients. Duration of total weight bearing 8–10 weeks in 9 (69.2%) IUN, 2 (15.3%) in
plating, 11–12 weeks in 4 (30.7%) ILN, 4 (30.7%) in plating, 13–14 weeks, and >14 weeks observed only in 2 (15.31%) plating
patients. Duration fracture union 16.9 (SD ± 1.48) in ILN, 20.7 (SD ± 1.84) in plating t-value 5.9 P < 0.001, post-surgical complications
– pain in anterior knee, 3 (23%) in ILN. superficial skin infection 1 (7.59%) in plating deep infection, 2 (15.3%) in plating valgus
>50 (angulations), 3 (23%) in IUL, and 2 (15.3%) in plating. Stiffing of knee 2 (15.3%) in ILN stiffness of ankle 1 (7.6%) in ILN,
3 (23%) in plating. Non-union 1 (7.6%) in ILN, implant irritation 3 (23%) in plating, and implant failure 1 (7.6%) in ILN.
Conclusion: Closed intermedullary nailing is preferable than planting technique because of early weight bearing, early union
and decreased implant related problems.

Author Biography

Medisetty Vinod Kumar, Nimra Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India

Assistant Professor, Department of Orthopaedics

References

1. Kawalkar AC, Badole CM. Distal Metaphyseal fractures;
which is better intramedullary nailing or minimally
invasive plate osteosynthesis? J Orthop Trauma Rehabil
2008;22:307-11.
2. Shrestha D, Acharya B. Minimally invasive plate
osteosynthesis with locking compression plate for distal
dimetaphyseal tibia fracture. Kathmandu Univ Med J
2011;34:62-8.
3. Im GI, Keg S. Distal metphyseal fractures of tibia.
A prospective randomised trial of closed reduction and
inter medullary nail versus open reduction and plate and
screw. Infect Crit Care 2005;59:1219-23.
4. Valier HA, Toan LT. Radiographic and clinical comparison
of distal tibia shaft fractures plating versus intermedullary
nailing. J Orthop Trauma 2008;22:307-11.
5. Schatzker J, Tile M. Rationale of Operative Fracture
Care. 3rd ed. Berlin, Heidelberg: Springer-Verlag; 2005. p.
475-6.
6. Bucholz R, Broun CC. Rockwood and Greens Fractures in
Adults. New York: Lippincott; 2015. p. 98-101.
7. Muller M, Nazarian S. The Comprehensive Classificationof Fractures of Long Bones. Berlin: Springer Verlag; 1990.
p. 88-94.
8. Labranci PJ, Franco JS. Treatment of distal fractures of
tibia. Acta Orthop Bras 2009;17:40-5.
9. Sarmeinto A, Latta LL. 450 closed fractures of distal third
of tibia treated with a functional brace. Clin Orthop Relat
Res 2004;428:261-71.
10. Hasenboehler DE, Rikli R. Locking compression plate with
minimally invasive plate osteosynthesis in diaphysis and
distal tibia fracture. A retrospective study of 32 patients.Injury 2007;38:365-70.
Published
2021-08-10
Section
Articles