Functional Outcome of Intramedullary Interlocking Nail and Plate Fixation in The Surgical Management in Distal Tibia Fracture: A Comparative Study

Abstract

Background: On the basis of the fracture location in the bone distal tibia fractures have the second highest incidence of all tibia fractures after the mid-shaft fracture of tibia[1]. we conducted this study comparing functional outcome of intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. The Patients with Distal tibia fracture were grouped in two. Group I patients were treated with Intramedullary interlocking nail; Group II patients were treated with open reduction and internal fixation with Plating. We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture.

Material and method: A prospective study was conducted in department of orthopaedic. All patients attending the orthopaedic department with extra-articular fracture of distal tibia who met the inclusion criteria were counselled regarding the disease and the study and those willingly consenting to participate in the study were selected. A total of 42 subjects were consecutively recruited for the study. The Patients with Distal tibia fracture who came to our hospital Grouped into Group I and Group II. For each Group, patients were selected consecutively. Group I (n=21) patients were treated with Intramedullary interlocking nail; Group II (n=21) patients were treated with open reduction and internal fixation with Plating. Clinical follow-up examination was performed at 4 weeks, 6 weeks, 10 weeks, 3 months, 6 months and 1 year. All patients were assessed clinically and radiographically with following terms such as tenderness at fracture site, abnormal mobility, infection, pain on movement of knee and ankle joints and antero-posterior and lateral radiographs of the leg for union of fracture. Assessment of the patient with Functional recovery was done with American orthopaedic foot and ankle surgery (AOFAS) minimum 6 months after injury.

Result: Our study showed that the mean operating time in nail i.e. Group I was 102.14 minutes, where in Group II 96.67 minutes. Mean union time in Group I was 18.43 weeks and 21.43 weeks in Group II. 2 patients had wound problem in group II. 3 patients complained knee pain from Group I. 3 patients had delayed union, 2 patients had malalignment, and one patient had non-union in Group I. 2 cases had superficial infections and delayed wound healing in Group II. Mean operating time and mean time of healing between Group I and Group II were statistically significant (p<0.05). 6(28.57%) patients had secondary procedure in nailing group. 3 patients had bone marrow aspiration, 2 had nail exchange and one case undergone dynamisation. The functional outcome was assessed by American ankle and foot score (AOFAS). In our study, 12 (57.14%) patients had excellent, 6 (28.58%) patients had good, 2 (9.52%) had fair and 1(4.76%) patients had poor functional outcome from Group I. In group II, 11(52.38%) patients had excellent, 8(38.1%) patients had good and 2(9.52%) patients had fair outcome. The comparison of the various parameters of this study with other published data shows that the results were comparable.

Conclusion: Based upon the findings of the present study, both the methods studied are suitable treatments in the surgical management of extra-articular distal tibia fracture. IM nailing shows lower rate of delayed wound healing and superficial infection but more likely to require additional surgeries to achieve union, and probably will have more complaints of pain in their limbs or knee. While plating avoids malunion and knee pain but the functional and efficacy outcomes appear to be similar between the two treatment groups. Therefore, the choice of surgical procedure should be based on the surgeon’s expertise, the clinical circumstances, and especially the patient’s injury pattern.