Reamed Intramedullary Nailing Versus Anatomic Plating by MIPO in Distal Tibia Extra-Articular Metaphyseal Fracture

摘要

Distal tibia metaphyseal extra-articular fractures are common injuries and despite of advancement in management, optimal surgical technique is still controversial because of their close proximity with ankle joint and soft tissue scarcity.Aim: To evaluate and compare the functional outcome of anatomic plating with minimally invasive plate osteosynthesis technique (MIPO) and reamed Intramedullary (IM) nailing for distal tibia extra articular metaphyseal fracture.Materials and Methods: Forty five patients with type Orthopaedic Trauma Association (OTA) 43A fracture were included and treated with anatomic plate fixation (Group A, n=20) and IM nailing (Group B, n=25) and followed up for minimum of two years. Results compared using independent student?s t-test and Oleurd Molandar score for functional evaluation.Results: No significant difference was found for mean union time (Group A 26.6±7.14 weeks, Group B 25.6±4.07 weeks, t-value 0.11, p-value 0.594), angulation (Group A 1.45±2.66°, Group B 3.54±3.66°, t-value 0.76, p-value 0.107) and shortening (Group A 0.21±0.32 cm, Group B 0.28±0.34 cm, t-value 0.009, p-value 0.446). Surgical time however was significantly shorter in Group B (Group A 94.5±10.11 minute, Group B 79±5.59 minute, t-value 2.0, p-value< 0.05). Malunion occured in one patient (5%) in Group A and in 4 patients (16%) in Group B. Mean Oleurd Molandar score in group A was 81.5±12.9 (range, 95-40) and in Group B was 82.4±11.5 (range 95-60).Conclusion: There was no difference pertaining to union rate, angulation, shortening and functional Oleurd Molandar score in IM nailing and anatomical plating groups however, IM nailing had the advantage of shorter surgical time. We conclude that both anatomical plating and IM nailing are possible treatment for distal tibia extra articular metaphyseal fracture.