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Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Purpose

The purpose of this randomized clinical trial is to compare intramedullary nailing (IMN) versus minimally invasive plate osteosynthesis (MIPO) for the treatment of extra-articular distal tibial shaft fractures.

Materials and methods

Twenty-five consecutive patients with distal extra-articular tibial fractures which were located between 4 and 12 cm from the tibial plafond (AO 42A1 and 43A1) were randomly assigned into IMN (n: 10) or MIPO (n: 15) treatment groups. All patients were followed for at least 1 year. Foot function index, time to weight bearing, union time, duration of operation, length of incision, intra-operative blood loss, intra-operative fluoroscopy time, rotational and angular malalignment, rate of infection, secondary interventions and complications were compared between groups.

Results

All patients completed the trial and were followed with a mean of 23.1 ± 9.4 months (range 12–52). Foot function index, weight bearing time, union time, rate of malunion, rate of infection and rate of secondary interventions were all similar between groups (p = 0.807, p = 0.177, p = 0.402, p = 0.358, p = 0.404, p = 0.404, respectively). Intra-operative blood loss, length of surgical incision, radiation time and rotational malalignment were higher in the IMN group (p = 0.012, p = 0.019, p = 0.004 and p = 0.027, respectively).

Conclusions

Results of our study showed that both treatment methods have similar therapeutic efficacy regarding functional outcomes and can be used safely for extra-articular distal tibial shaft fractures, and none of the techniques had a major advantage over the other.

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References

  1. Busse JW, Morton E, Lacchetti C, Guyatt GH, Bhandari M. Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons. Acta Orthop. 2008;79(5):689–94.

    Article  PubMed  Google Scholar 

  2. Bong MR, Kummer FJ, Koval KJ, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15(2):97–106.

    PubMed  Google Scholar 

  3. Höntzsch D, Blauth M, Attal R. Angle-stable fixation of intramedullary nails using the Angular Stable Locking System® (ASLS). Oper Orthop Traumatol. 2011;23(5):387–96.

    Article  PubMed  Google Scholar 

  4. Laflamme GY, Heimlich D, Stephen D, Kreder HJ, Whyne CM. Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma. 2003;17(7):496–502.

    Article  CAS  PubMed  Google Scholar 

  5. Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H. The mechanical effect of blocking screws (poller screws) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma. 1999;13(8):550–3.

    Article  CAS  PubMed  Google Scholar 

  6. Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37(6):531–5.

    Article  PubMed  Google Scholar 

  7. Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20(11):675–83.

    Article  PubMed  Google Scholar 

  8. 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(7):984–8.

    Article  CAS  PubMed  Google Scholar 

  9. 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(12):736–41.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38(6):1261–7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mauffrey C, McGuinness K, Parsons N, Achten J, Costa ML. A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. J Bone Joint Surg Br. 2012;94(5):704–8.

    Article  CAS  PubMed  Google Scholar 

  13. Xue XH, Yan SG, Cai XZ, Shi MM, Lin T. Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis. Injury. 2014;45(4):667–76.

    Article  PubMed  Google Scholar 

  14. Budiman-Mak E, Conrad KJ, Roach KE. The foot function index: a measure of foot pain and disability. J Clin Epidemiol. 1991;44(6):561–70.

    Article  CAS  PubMed  Google Scholar 

  15. Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005;59(5):1219–23.

    Article  PubMed  Google Scholar 

  16. Lefaivre KA, Guy P, Chan H. Blachut PA Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525–9.

    Article  PubMed  Google Scholar 

  17. Iqbal HJ, Pidikiti P. Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence. Foot Ankle Surg. 2013;19(3):143–7.

    Article  CAS  PubMed  Google Scholar 

  18. Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014;28(9):542–8.

    Article  PubMed  Google Scholar 

  19. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury. 2011;42(10):975–84.

    Article  CAS  PubMed  Google Scholar 

  20. Anastopoulos G, Ntagiopoulos PG, Chissas D, Papaeliou A, Asimakopoulos A. Distal locking of tibial nails : a new device to reduce radiation exposure. Clin Orthop Relat Res. 2008;466(1):216–20.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kuhn S, Appelmann P, Mehler D, Pairon P, Rommens PM. Retrograde tibial nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures. J Orthop Surg Res. 2014;13(9):35.

    Article  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Author notes

  1. Ozkan Kose

    Present address: , Uncalı Mah. Toroslar cad., Samut Comfort Palace E2 Koyaaltı, Antalya, Turkey

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey

    Atilla Polat, Kerem Canbora & Serhat Yanık

  2. Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital, Antalya, Turkey

    Ozkan Kose & Ferhat Guler

Authors
  1. Atilla Polat
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  2. Ozkan Kose
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Corresponding author

Correspondence to Ozkan Kose.

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Polat, A., Kose, O., Canbora, K. et al. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial. J Orthop Sci 20, 695–701 (2015). https://doi.org/10.1007/s00776-015-0713-9

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  • DOI: https://doi.org/10.1007/s00776-015-0713-9

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