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Treatment of distal tibial fractures: plate versus nail

A retrospective outcome analysis of matched pairs of patients

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Abstract

A study of 24 patients who sustained an extra-articular fracture of the distal third of the tibial shaft was performed to determine the effect of the type of treatment, open reduction and internal fixation (ORIF) or closed reduction and intramedullary (IM) nailing, on the occurrence of malalignment. All patients were treated in our clinic between 1993 and 2001 for a fracture in the distal third of the tibia. Twelve patients treated with ORIF were matched to 12 patients treated with IM nailing, with regard to gender, age decade, and the AO classification of the fracture. The group treated with IM nailing was assessed after a mean 6.0 years versus ORIF after a mean of 4.5 years. Two patients treated with ORIF versus six patients treated with IM nailing had a malalignment of the tibia. Furthermore, we found no difference with regard to time to union, non-union, hardware failure or deep infections between ORIF and IM nailing. Our results suggest that control of alignment is difficult with IM nailing of distal tibial fractures. For optimal alignment we advise considering the use of ORIF for closed and type I open extra-articular fractures in the distal third of the tibia.

Résumé

Nous avons étudié 24 patients présentant une fracture extra articulaire du tiers distal de la diaphyse tibiale afin de déterminer quel était le meilleur type de traitement. Les patients ont été traités soit par réduction sanglante et fixation interne (ORIF) soit par réduction fermée et enclouage centromédullaire. Tous les patients ont été traités dans notre établissement entre 1993 et 2001. Douze patients traités par ostéosynthèse interne ont été comparés à 12 patients traités par enclouage centromédullaire, ces deux groupes étant comparables également en terme de sexe, d’âge, de classification AO. Le groupe traité par enclouage centromédullaire a été suivi pendant une moyenne de 6 ans alors que le groupe par ostéosynthèse, sur une moyenne de 4,5 ans. Deux patients traités par ostéosynthèse interne versus 6 patients traités par enclouage centromédullaire ont présenté un cal vicieux du tibia. Nous n’avons pas trouvé de différence significative sur le plan de la consolidation, du taux de pseudarthrose, du débricolage ou sur le taux d’infection. Nos résultats nous permettent de penser qu’il est plus difficile de traiter ce type de fracture avec l’enclouage centromédullaire et, nous conseillons, pour ce type de fractures fermées ou ouvertes de type I de faire un traitement pas ostéosynthèse interne.

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Correspondence to Albert van Kampen.

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Janssen, K.W., Biert, J. & van Kampen, A. Treatment of distal tibial fractures: plate versus nail. International Orthopaedics (SICO 31, 709–714 (2007). https://doi.org/10.1007/s00264-006-0237-1

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  • DOI: https://doi.org/10.1007/s00264-006-0237-1

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