| Objective The distal tibial fracture is common type in our clinical treatment, most of these fractures are caused by high energy injury, accounting for about 37.8 percent of tibial fracture. There are variety of treatment methods of distal tibial fracture. However, every mehtod has its own advantages and disadvantages, controversy still persists regarding the treatment of distal tibial fracture. Recently, closed reduction and Intramedullary Nail(IMN) internal fixation and closed reduction MIPPO(Minimally Invasive Percutaneous Plate Osteosynthesis) technique are still two main therapies of distal tibial fracture. The aim of this study was to compare effect of treatment, time of fracture healing and rate of complications of Expert Tibia Nail and MIPPO technique combined with locking compression plate(LCP) in treatment of distal tibial fracture. Summarize the clinical experience and data of study, in order to provide reference for our future clinical treatment.Method Retrospective analysis 73 patients of distal tibial fracture with mean age 46.18±16.35years(range 18- 84), which were treated in the First Hospital Affiliated to Dalian Medical University from 2009 August to 2014 February. 45 cases of those were male and other 28 cases were female. Left side were 34 cases, on the right side of 39. The causes of injury include car accident in 33 cases, high falling injury in 14 cases, 6 cases of sports injury and sprain injury in 18 cases. According to the AO/OTA classification, 24 were type 43-A1, 16 were type 43-A2, 31 were type 43-A3 and 2 were type 43-B1. All the patients were divided into two groups according to the different treatment method, Group A(Expert Tibail Nail) 37 cases with mean age 44.05±15.98 years(range 18-78 years) and Group B(MIPPO) 36 cases with mean age48.33±16.68 years(range 18-84 years). Record and compare operation waiting time, operation time, time to begin weight bearing, time of fracture healing and postoperative complications of two groups, and to judge the advantages and disadvantages of two different operation methods.Result All the patients were followed up for average 21.25 months(range 12-36 months). The mean time from injury to admission was 6.04 hours(range 0.5-78 hours). 3 cases occurred incision split in MIPPO group, but no statistical difference in comparison with IMN group. There were no statistical difference between two groups in hospital admission time, length of incision, deep infection, malunion, delay union, nonunion or osteomyelitis(P>0.05). What’s more, in two groups,the time of operation and beginning to bear load was similar, which showed no significant statistical difference. IMN group has significantly shorten operation waiting time, union time and less in postoperative complications(P<0.05). Using Fisher exact probability test to prove that the rate of superficial and deep infection is higher in open fractures(P<0.05).Conclusion All the patients obtained bone union. Both two kinds of operation methods are common ways in treating of distal tibial fracture. Intramedullary Nail can decrease operation waiting time, fracture healing time and the rate of wound complications. Thus, we advocate of using closed reduction and Intramedullary Nail internal fixation to treat distal tibial fractures. |
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