Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome
- 120 Downloads
The aim of this study is to compare clinical and radiological outcome of intramedullary nailing (IMN) and locked plate (LP) in patients affected by fracture of the distal tibia (DTF). We performed also an analysis to identify predictive factors of unfavourable outcome.
Data about patients with DTF treated at our first level trauma centre between 2008 and 2017 were collected. Patients were divided in group 1 (IMN) and group 2 (LP). The inclusion criteria were age at least 18 years at the time of diagnosis and unilateral DTF (closed or Gustilo 1). Demographic variables and data related to surgical procedure and hospitalization were registered. X-ray at follow-up was reviewed to identify malunions and nonunions. Clinical outcome was evaluated using scores and registering any complication.
One hundred two patients were included in group 1 and 81 in group 2. In group 2 were documented higher operating time and hospitalization. The mean union time was 20.2 weeks for IMN and 24.8 weeks for LP group (p = 0.271). The rate of infections and wound complications was higher in group 2 while malunion and anterior knee pain were more frequent in group 1. No difference in scores for clinical outcome was documented after six months. The full-weight bearing time was significantly longer in the LP group (p = 0.019). At multivariate analysis, no variables showed a predictive power for unfavourable outcome.
Clinical and radiological results of LP and IMN appear similar. No predictive factors of unfavourable outcome were identified.
KeywordsDistal tibial fracture Plate fixation Intramedullary nailing Outcome Fibular fracture
Compliance with ethical standards
The Local Research Ethics Service approved the study, which was conducted following the principles of Declaration of Helsinki. All patients signed informed consent.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 315:25–33Google Scholar
- 9.Costa ML, Achten J, Griffin J, Petrou S, Pallister I, Lamb SE, Parsons NR, FixDT Trial Investigators (2017) Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia: the UK FixDT randomized clinical trial. JAMA 318:1767–1776CrossRefGoogle Scholar
- 18.Maredza M, Petrou S, Dritsaki M, Achten J, Griffin J, Lamb SE, Parsons NR, Costa ML (2018) A comparison of the cost-effectiveness of intramedullary nail fixation and locking plate fixation in the treatment of adult patients with an extra-articular fracture of the distal tibia. Bone Joint J 100(5):624–633CrossRefGoogle Scholar