A Comparative Study of Distal Tibia Fractures Treated with Intramedullary Nailing versus Plating by MIPPO

Abstract

BACKGROUND Tibia is the major weight bearing bone of the leg. It is the most commonly fractured long bone in the body with an annual incidence of Tibial shaft Fractures is two per 1000 individuals. Tibial fractures can cause a long morbidity and extensive disability unless treatment is appropriate. We wanted to assess extraarticular distal tibial fractures and compare the two surgical modalities of treatment i.e.; intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPPO). We also wanted to compare the clinical, radiological and functional outcome of these modalities of treatment. METHODS This is a prospective study conducted among 40 patients in the age group of 20-70 yrs., of both sexes taken up for intramedullary nailing/ MIPPO at Rajarajeswari Medical College and Hospital, Bangalore. Age group ranged from 22 to 62 years with majority of patients having RTA (77.5%). Duration of hospital stay in majority was about 10 days and IMN for 7 days. Union time in weeks for MIPPO group was about 20 weeks and in Intra Medullary Nailing group was about 18 weeks. Both intramedullary nailing and plating by MIPPO are the optimal methods of treatment in extra articular distal tibia fractures with no significant differences between union and complication rates. MIPPO is usually preferred in fractures which are within the AO muller square whereas IMN is preferred in fractures which are above it. RESULTS In MIPPO group, mode of injury was RTA in 70% and self-fall in 30% and in Intra Medullary Nailing group, mode of injury was RTA in 85% and self-fall in 15%. There was no significant difference in mode of injury between the two groups. In MIPPO group, 5% had Gustilo Anderson Grade 1 and in Intra Medullary Nailing group 10% had Gustilo Anderson Grade 1. There was no significant difference in Gustilo Anderson Grade 1 between the two groups. CONCLUSIONS Both intramedullary nailing and plating by MIPPO are the optimal methods of treatment in extraarticular distal tibia fractures with no significant difference between union and complication rates. MIPPO is usually preferred in fractures which are within the AO muller square whereas IMN is preferred in fractures which are above it.

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

“…Shingati et al compared intramedullary nailing with plating for distal tibia fracture patients. 10 The cases due to road traffic accidents were 85% in the nailing group compared to 70% in the plating group but the difference was not found out to be statistically significant. Gustilo Anderson grade 1 was seen in 5% of the cases in plating group compared to 10% in the nailing group.…”