The Outcome Between Interlocking Minimally Invasive Percutaneous Plating And Interlocking Intramedullary Nailing In Treating With Fractures Of The Lower Tibia

Tibial fracture at lower segment is a common fracture, most fractures of tibial are at this place. And because of the specific anatomical characteristics of distal tibia such as little soft tissue covering, poor blood supply and fractures always associating with soft tissue injury, the fractures at this place are difficult to heal. In addition, tibial fracture at lower segment is often associated with fibular fracture which leads to a unstable fracture, this makes operation difficult. Along with the increasing of social economy and the degree of mechanization, such fractures are increasing year by year, and fractures are more multiplex and complex. Because of these changes, improvements and revolutions have taken place in technology. Currently, the non-surgical treatments of tibial fracture at lower segments such as closed reduction, plaster, external fixation and traction have certain effect, in addition, a variety of external fixation has also been applied, but the Interlocking Minimally Invasive Percutaneous Plating or Interlocking Intramedullary Nailing has been widely applied in clinical in treating tibial fracture at lower segments, which has become the main treatment, and achieved satisfactory clinical results.Objective: To compare the clinic effects in treating tibial fracture at lower segments between the Interlocking Minimally Invasive Percutaneous Plating and Interlocking Intramedullary Nailing. To improve surgical treatments and clinic outcome of tibial fracture at lower segments.Methods: Between January 2008 and January 2010,56 cases of distal tibia fracture were treated in our department.With Minimally Invasive percutaneous plate were applied in 28 cases,and interlocking intramedullary nails in 28 cases.All the patients were followed up for averagely 19.6 month(from 12 to 26 months).Their functional and radiographic outcomes were collected to compare the differences in operation time,intra-operative blood loss, X-ray exposure,bone union time, post-operative complications,posterior or anterior angulation of ankle joint,varus or valgus angulation of ankle joint, and the maximum ankle dorsinexion degrees.Kofoed ankle score system was used to evaluate the results.Results: All patients received 12 to 26 months (19.6 months), two groups of patients in the operative time, fluoroscopy times, the maximum ankle dorsiflexion was no significant difference in degree of respect (P> 0.05). All fractures healed, with an average healing time of intramedullary nail group was 20.6 weeks, the steel group was19.2weeks. 0lerud-Molander ankle score results were excellent. Intramedullary nail group with less blood loss, steel group has better fracture alignment; intramedullary nail group, 4 patients had malunion, and plating group, 3 cases of local soft tissue complications.Conclusion: The minimally invasive percutaneous locking compression plate and interlocking intramedullary nailing used for distal tibial fractures are both effective. Percutaneous plate is better when the soft tissue is excellent which is suit for complicated fracture at lower tibia and Metaphyses or articular fractures. It can provide better alignment, more reliable fixation and anatomical reduction. And interlocking intramedullary nailing has better effective in treating fractures with local soft tissue injury, which can prevent iatrogenic injury of tissue, and also provide reliable fixation.