Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures

Abstract

Purpose The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures. Methods Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed.

Unreamed intramedullary nailing in distal tibial fractures

“…Nonunion occurred in 8 % of the fractures in this study. This compares favourably to the reports by Im and Tae [6] and Vallier et al [32] nailing groups, whereby the rate of delayed and non-union after nailing distal tibial fractures vary between 0 and 23 % in the literature [3,6,8,13,14,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Screw failure remains a common problem with small diameter nails [2,15,16].…”

“…This may support early dynamisation in axially stable fractures to avoid delayed union and fatigue failure of the locking screws. Multiple prospective [6,[32][33][34] and retrospective [7,8,31] studies comparing open plating and locked intramedullary nailing for distal tibial fractures have described similar results as regards infection, secondary procedures, time to union (17-27 weeks) and rate of non-union (0-9 %) for both techniques. Whereas nailing has the advantage of shorter operative duration and reduced wound problems, ORIF can restore alignment better than nailing that was associated with more malunion (Table 2).…”

“…Wide open reduction and internal fixation (ORIF) replaced the traditional non-operative treatment of these injuries in the late 1960s. Reviewing the results of ORIF has demonstrated a high risk of soft tissue complications including chronic infection [4][5][6][7][8]. External fixation has gained popularity in treating open fractures since the 1980s but as a definitive treatment has been frequently associated with impaired bone healing and pin site problems [4,9].…”

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

“…Although previous studies have compared plates with intramedullary nails [1][2][3][4][5]10], plates with external fixation [7] and intramedullary nails with external fixation [6], few data are available on the three methods above. The minimally invasive plate osteosynthesis (MIPO) technique has gained prevalence in recent years.…”

“…Plates, intramedullary nails and external fixations are three well-accepted and effective methods, but each has been historically related to complications. Infections, wound complications and implant prominence are frequently reported after tibial plating [1,2,[8][9][10], whereas malalignment and knee pain have been associated with nailing in other studies [11][12][13][14][15]. Frequent need for secondary operations, prolonged healing time and pin tract infection are inherent problems in external fixation [16,17].…”