Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures


  • Anil Kumar Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Johney Juneja Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Raghvendra Choubisa Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Nitin Jeenjwadia Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • A. K. Mehra Department of Orthopaedics, RNT, Udaipur, Rajasthan, India
  • Ramesh Sen Orthopaedic Department, Max Hopsital, Mohali, Punjab, India



Tibial fractures, Malunion, Bone plates, Intramedullary interlocking nailing


Background: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.

Methods: This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.

Results: Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.

Conclusions: Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.


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Original Research Articles