Comparison Of Outcomes And Complications Of Intramedullary Nailing And Minimal Invasive Percutaneous Plating For Extra-articular Distal Tibia Fractures

The main aim of the study was to analyze the functional outcomes and the complications of Intramedullary Nailing(IMN)and the Minimal Invasive Percutaneous Plating(PLP)for Extra-articular Distal Tibia Fractures.Methods:Retrospective database of all patients between January 2011 and December 2015 with Extra-articular distal tibia fracture who had undergone surgery using either intramedullary nailing or minimally invasive percutaneous locked plating was obtained.Patients’ charts were retrospectively reviewed to analyze presentation,type of injury and management for the distal tibia fracture.All available follow up data was reviewed.Results:A total of 58 patients met the inclusion criteria for the study.They were divided into two groups:IMN Group and PLP Group.Constant score questionnaire was completed for all these 58 patients.Level of significance for the differences in functional outcome between the two groups was calculated using Non-parametric Mann Whitney U test.Some results were statistically not significant in comparison.IMN group had more delayed union and malalignment cases while PLP group had more cases of soft tissue infection.5.5%(2 in 36)cases in IMN group had malalignment while 9%(2 in 22)cases in PLP group had soft tissue infection.84%cases(30 patients)in IMN group and 86%(19 patients)in PLP cases had a very good Range of movements of the associated joints and as a whole affected lower leg.All 58 patients were followed up during the study,some patients had secondary procedures and longer hospital stay days.But there was no difference for two groups of patients.Average weight bearing time in IMN group patients was significantly shorter(27 days in IMN group versus 42 days in PLP group).Conclusion:Both IM nailing and Minimally Invasive PLP had similar functional outcomes and complication rates,however malalignment and delayed union was more frequent in patients treated with IM nails.We believe difficulty in reducing and stabilizing distal metaphyseal tibia(4-10 cm proximal to plafond)due to increased diameter of the intramedullary canal is the main cause for the malalignment and delayed union.Soft tissue infection rate was higher in PLP group,post-operative weight bearing time was comparatively longer in PLP group.But the recent more advanced minimal invasive techniques of plating were found to have less complication and better outcomes.In conclusion both the methods of treatment could be effective for the treatment of extra-articular distal tibia metaphyseal fracture,both have resulted in very good functional outcomes.Choice of method for the treatment must be done according to the nature of the fracture and personality of the wound.