Comparative study of functional outcome of distal one-third shaft tibia fractures treated with tip locking tibia nailing versus precontoured anatomical locking plate
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20230462Keywords:
PCALP, TLIMN, Distal one-third shaft tibia, Extra-articularAbstract
Background: The distal 1/3rd shaft tibia extra-articular fractures are treated with both tip locking intra-medullary nailing (TLIMN) and precontoured anatomical locking plates (PCALP). The aim of this study was to compare the results of TLIMN and PCALP in distal tibia fractures and to determine dominant strategies. The complications and functional outcome in both groups were compared.
Methods: Forty patients with distal 1/3rd shaft tibia were randomly assigned to TLIMN (group 1) and PCALP group (group 2). The functional outcomes were evaluated using American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications like infection, delayed union, non-union, malunion, hardware prominence and secondary interventions were compared.
Results: The average union time was 15.05±3.33 weeks in group 1 and 13.4±2.46 weeks in group 2 (p=0.045). The mean AOFAS score at 1 year follow up was 89.8±6.13 in group 1 and 89.1±6.15 in group 2 (p=0.262). Five patients in group 1 and one in group 2 had mal-alignment. Deep infection was present in one and superficial infection was present in two cases in group 2. Four patients in group 1 developed anterior knee pain and five patients in group 2 had hardware prominence.
Conclusions: We conclude that tip locking intra-medullary nail is a reliable and satisfactory method for treatment of fractures of distal 1/3rd shaft tibia AO type 42A, 42B and 42C fractures with good functional outcomes and high union rates with comparatively low complications. Prevalence of malunion was higher in TLIMN group and hardware prominence was more prevalent in PCALP group. Implant removal are more in PCALP group mostly due to implant irritation.
References
Haonga BT, Areu MMM, Challa ST, Liu MB, Elieza E, Morshed S, et al. Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute. SICOTJ. 2019;5:20.
Kumar A, Juneja J, Choubsia R, Jeenjwadia N, Mehra AK, Rameshsen. Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures. Int J Res Orthop. 2021;7: 1177-84.
Chitten JJ, Balasubramaniam R. A comparative study of locking plate by minimally invasive percutaneous plate osteosynthesis versus closed interlocking intramedullary nail in extra-articular distal tibia fractures. Int J Res Orthop. 2021;7:557-60.
Wong Wei Kang N, Tan WPJ, Phua YMC, Min ATG, Naidu K, Umapathysivam K, Smitham PJ. Intramedullary nail: the past, present and the future - a review exploring where the future may lead us. Orthop Rev (Pavia). 2021;13(2):25546.
Lakhotia D, Meena A, Bishnoi M, Sharma K, Shinde P. Prospective comparative study of extra-articular distal tibia fractures intramedullary nailing versus medial minimally invasive percutaneous plating. Int J Res Orthop 2020;6:581-6.
Prakashappa TH, Madhusudan B, Bharath M, Nagaraju H, Ashwin S. A prospective comparative study of functional outcome of distal extra articular tibia fracture fixed with intramedullary nail versus locking compression plate. Int J Res Orthop. 2022;8:457-62.
Paul S. Minimally invasive plate osteosynthesis (MIPO) in long bone fractures biomechanics design clinical results. In: Biomechanics in Applications. London: IntechOpen; 2011;10.5772/21189.
Singla A, Goyal D, Sandhu KS, Karamdeep Singh Kahal, Dharmpal. Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures. Int J Orthop Sci. 2021;7(3):737-42.
Mudgal A, Daolagupu AK, Agarwaja V, Sinha AK. Management of fractures of the extra articular distal tibia by minimally invasive plate Osteosynthesis-A prospective series of 21 patients. Int J Med Res Health Sci. 2010;4:276-82.
Kumar A, Charlebois SJ, Cain EL. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg Am. 2003;85:604-8.
Sanjeev S, Sahni G, Kumar S, Jain AK, Behl T. Comparative study of functional outcome of minimally invasive plate Osteosynthesis versus open reduction and internal fixation with locking compression plate in distal 1/3rd shaft tibia fractures. Int J Orthop Sci. 2019; 5(4):149-52.
Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH. Effect of unreamed, limited reamed, and standard re-amed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma. 2001;15(1):18- 27.
Jafarinejad AE, Bakhshi H, Haghnegahdar M, Ghomeishi N. Malrotation following reamed intramedullary nailing of closed tibial fractures. Indian J Orthop. 2012;46:312-6.
Jain RK, Khare R, Jain N, Deshpande M. Study of management of distal 1/3rd tibial shaft fracture by intramedullary nailing. Nat J Clin Orthop. 2019;3(4): 29-35
Freude A. Controlled dynamic stability as the next step in “biologic plate osteosynthesis” - a pilot prospective observational cohort study in 34 patients with distal tibia fractures. Patient Safety Surg. 2014;8:3.
Krackhardt T, Dilger J, Flesch I, Hontzsch D, Eingartner C, Weise K. Fractures of the distal tibia treated with closed reduction and minimally invasive plating. Arch Orthop Trauma Surg. 2005;125(2):87-94.
Alho A, Benterud JG, Hogevold HE, Ekeland A, Strom- soe K. Comparison of functional bracing and locked in- tramedullary nailing in the treatment of displaced tibial shaft fractures. Clin Orthop. 1992;277: 243-50.
Rabari Y, Somani A, Saji MA, Prasad DV, Gupta R, Sharif N. Treatment of distal 1/3 tibia fractures: plating versus intramedullary nailing-A prospective comparative study. Int J Orthop Sci. 2017;3(2):720-2.
Bhat R1, Wani MM, Rashid S, Akhter N. Minimally invasive percutaneous plate osteosynthesis for closed distal tibial fractures: a consecutive study based on 25 patients. Eur J Orthop Surg Traumatol. 2015;25(3): 563-8.
Duckworth AD, Jefferies JG. Type C tibial pilon fractures: short- and long-term outcome following operative intervention. Bone Joint J. 2016;98(8):1106-11.
