Journal List > J Korean Foot Ankle Soc > v.19(3) > 1043379

Kim, Gwak, Lee, and Jung: Comparison of the Results between Intramedullary Nailing and Plate Fixation for Distal Tibia Fractures

Abstract

Purpose

We analyzed and compared the clinical and radiologic results between minimally invasive plate osteosynthesis and internal fixation using intramedullary (IM) nail in the treatment of distal tibia fractures.

Materials and Methods

From March 2005 to June 2013, 65 cases of distal tibia fractures treated with either plate fixation or IM nail fixation were analyzed retrospectively by clinical and radiologic evaluations. The clinical results were compared using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Olerud-Molander ankle score (OMAS), and visual analogue scale (VAS) score at the last follow-up. The radiologic results were compared by time to bone union, complications such as nonunion, delayed union, and malunion.

Results

The clinical results (according to OMAS, AOFAS score, and VAS score) were 77.47, 84.76, and 1.75, respectively, in the plating group, and 90.21, 91.00, and 1.25, respectively, in the nailing group, and there was no statistically significant difference. Plating group showed earlier union than the nailing group and the nailing group showed higher frequency of non-union and delayed union than plating group.

Conclusion

In treatment of distal tibia fractures, two methods showed appropriate results. Therefore, thorough investigation of the types of fracture, state of soft tissues, and advantages and disadvantages of the two methods should be conducted in the treatment of distal tibia fractures.

References

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Figure 1.
(A) This photograph demonstrates cannulated tibia nail (CTN; Synthes, Solothurn, Switzerland). (B) Anteroposterior view of the left tibia show stabilized distal tibial fracture by the CTN. (C) Lateral view of the left tibia show stabilized distal tibial fracture by the CTN.
jkfas-19-86f1.tif
Figure 2.
(A) This photograph demonstrates expert tibial nail (ETN; Synthes, Solothurn, Switzerland). (B) Anteroposterior view of the right tibia show stabilized distal tibial fracture by the ETN. (C) Lateral view of the right tibia show stabilized distal tibial fracture by the ETN.
jkfas-19-86f2.tif
Figure 3.
(A) This photograph demonstrate locking compression plate distal medial tibia (LCP-DMT; Synthes, Solo-thurn, Switzerland). (B) Anteroposterior view of the right tibia show stabilized distal tibial fracture by the LCP-DMT plate using minimal invasive technique. (C) Lateral view of the right tibia show stabilized distal tibial fracture by the LCP-DMT plate using minimal invasive technique.
jkfas-19-86f3.tif
Figure 4.
(A) This photograph demonstrate locking compression plate distal medial tibia low bend (LCP-DMT low bend; Synthes, Solothurn, Switzerland). (B) Anteroposterior view of the left tibia show stabilized distal tibial fracture by the LCP-DMT low bend plate using minimal invasive technique. (C) Lateral view of the left tibia show stabilized distal tibial fracture by the LCP-DMT low bend plate using minimal invasive technique.
jkfas-19-86f4.tif
Table 1.
Demographics Data of Patients
  Plating group (n=25) Nailing group (n=18)
Mean age (yr) 47 (20∼59) 52 (24∼60)
Gender (male/female) 14/11 10/8
AO/OTA classification    
 42-A1 2 6
 42-A2 2 6
 42-A3 6 5
 42-C2 8 1
 42-C3 7 0

Values are presented as number of patients or mean (range).

AO/OTA: The AO Foundation and Orthopaedic Trauma Association.

Table 2.
Comparison of Clinical Results between Plating and Nailing Groups
  Plating group Nailing group p-value
OMAS 77.47±16.67 90.21±8.47 0.006
AOFAS score 84.76±9.42 91.00±8.51 0.005
VAS score 1.75±0.87 1.25±0.75 0.013
Secondary procedure 5 2 0.381
Complication 3 1 0.606
Infection 3 1 0.628

Values are presented as mean±standard deviation or number only.

OMAS: Olerud-Molander ankle score, AOFAS: American Orthopaedic Foot and Ankle Society, VAS: visual analogue scale.

Table 3.
Comparison of Radiological Results between Plating and Nailing Groups
  Plating group Nailing group p-value
Time to union (mo) 3.5±1.7 3.8±1.3 0.746
Delayed union 1 3 0.606
Nonunion 1 3 0.505
Deformity 0 1 0.381

Values are presented as mean±standard deviation or number only.

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