Retrospective analysis of minimal invasive plating versus intramedullary nailing for the treatment of extra-articular distal tibia fracture


  • Yogesh Soni Department of of Orthopaedics, SSIMS, Bhilai, Chhattisgarh, India
  • Ghanshyam Kakadiya Department Orthopaedics, T.N.M.C. and B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India
  • Akash Shakya Department of Orthopaedics, ESIC and PGIMSR, Andheri, Mumbai, Maharashtra, India
  • Viraj Gandbhir Department Orthopaedics, T.N.M.C. and B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India



IMILN, MIPPO, Extra-articular distal tibia, Olerud Molander ankle score


Background: The volume of cases of distal tibia fractures at the trauma care centre are quite high in the Indian scenario. This type of fracture often creates a dilemma for the orthopaedic surgeons over the choice of the implant for the management. The aim of our study was to compare intramedullary interlocking nail (IMILN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) based on various parameters.

Methods: We collected data of 40 patients with extra-articular distal tibial fractures (within 2 muller square from tibial plafond). Patients were divided into two groups: IMILN and MIPPO. We compared the 2 groups for demographic variables, union time, complication rate and functional score.

Results: There was no statistical difference in union time, complication rate, functional outcome and other demographic variables among the groups. Only 2 patients developed non-union and two patients had an infection. Overall 38 patients obtained excellent or good results (95%) and two patient had fair outcomes (5%).

Conclusions: The overall analysis suggested that both MIPPO and IMILN treatment options are comparable with consideration of all the parameters. Detailed results indicate a superiority of MIPPO over IMILN in terms of better anatomical reductions of the fracture with less incidence of malalignment while IMILN is better in terms of having lower rates of infections.

Author Biography

Yogesh Soni, Department of of Orthopaedics, SSIMS, Bhilai, Chhattisgarh, India

assistant professor


Schatzker J, Tile M. The rationale of operative fracture care. 3rd ed. Springer-Verlag Berlin Heidelberg. 2005;475-6.

Drosos G, Karnezis IA, Bishay M, Miles AW. Initial rotational stability of distal tibial fractures nailed without proximal locking: the importance of fracture type and degree of cortical contact. Injury. 2001;32:137-43.

Obremskey WT, Medina M. Comparison of intramedullary nailing of distal third tibial shaft fractures:before and after traumatologists. Orthop. 2004;27:1180-4.

Duda GN, Mandruzzato F, Heller M, Goldhahn J, Moser R, Hehli M, et al. Mechanical boundary conditions of fracture healing: Borderline indications in the treatment of unreamedtibial nailing. J Biomech. 2001;34:639-50.

Habernek H, Kwasny O, Schmid L, Ortner F. Complications of interlocking nailing for lower leg fractures: A 3-year follow up of 102 cases. J Trauma. 1992;33:863-9.

Attal R, Hansen M, Kirjavainen M, Bail H, Hammer TO, Rosenberger R et al. A multicentre case series of tibia fractures treated with the expert tibia nail. Arch Orthop Trauma Surg. 2012;132(7):975-84.

Moongilpatti Sengodan M, Vaidyanathan S, Karunanandaganapathy S, Subbiah Subramanian S, Rajamani SG. Distal tibial metaphyseal fractures:does blocking screw extend the indication of intramedullary nailing? ISRN Orthop. 2014;542-623.

Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: A human cadaveric study. J Orthop Trauma. 2002;16:691-5.

Toms AD, McMurtie A, Maffuli N. Percutaneous plating of the distal tibia. J Foot Ankle Surg. 2004;43:199-203.

Costa ML, Achten J, Griffin J, Petrou S, Pallister I, Lamb SE, Parsons NR. Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia. JAMA. 2017;318(18):1767-76.

Ram GG, Kumar D, Phagal VV. Surgical dilemma’s in treating distal third leg fractures. Int Surg J. 2014;1(1):13-6.

Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213-21.

Lakhotia D, Meena A, Bishnoi M, Sharma K, Shinde P. Int J Res Orthop. 2020;6(3):581-6.

Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg. 1984;103(3):190-4.

Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, et al. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthop Surg Res. 2015;10:95.

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25:736-41.

Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, et al. Comparison of low, multidirectional locked nailing and plating in thetreatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012;36:1457-62.

Resch H, Pechlaner S, Benedetto KP. Long term results after conservative and surgical treatment of fractures of the distal end of tibia. Aktuelle Traumatol. 1986;16:117-23.

Kumar D, Ram GG, Vijayaraghavan PV. Minimally invasive plate versus intramedullary interlocking nailing in distal third tibia fractures. IOSR J Dent Med Sci. 2014;13:15-7.

Pawar ED, Agrawal SR, Patil AW, Choudhary S, Asadi G. A comparative study of intramedullary interlocking nail and locking plate fixation in the management of extra articular distal tibial fractures. J Evol Med Dent Sci. 2014;3:6812-26.

Daolagupu AK, Mudgal A, Agarwala V, Dutta KK. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures. Indian J Orthop. 2017;51:292-8.

Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31(5):709-14.

Bisaccia M, Cappiello A, Meccariello L, Rinonapoli G, Falzarano G, Medici A, Vicente CI, Piscitelli L, Stano V, Bisaccia O, Caraffa A. Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes. SICOT-J. 2018;4:2.

Barcak E, Collinge CA. Metaphyseal distal tibia fractures: a cohort, single-surgeon study.comparing outcomes of patients treated with minimally invasive plating versus intramedullary nailing. J Orthop Trauma. 2016;30(5):169-74.

Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92:984-8.






Original Research Articles