Skip to main content
SpringerLink
Log in

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

International Orthopaedics Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

A few studies focused on the methods of treatment for displaced distal tibial shaft fractures have been published, all of which compared two different methods. In this randomized, prospective study, we aimed to compare minimally invasive plate osteosynthesis, locking intramedullary nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation for distal tibial shaft fractures by assessing complications and secondary procedures.

Methods

From November 2002 to June 2012, 137 skeletally mature patients with displaced distal tibial shaft fractures with or without fibula fracture were randomized to be treated by minimally invasive plate osteosynthesis (group A, n = 46), locking intramedullary nail (group B, n = 46) or external fixation combined with limited open reduction and absorbable internal fixation (group C, n = 45). Age, gender, mechanism of injury, fracture pattern and presence of open fracture were equally distributed among the three groups. Indexes for evaluation included hospital stay, operative time, time to radiographic union, union status, infection and the incidence of re-operation. Mazur ankle score was introduced for functional evaluation. Statistics Analysis System (SAS) 9.2 was used for analysis.

Results

A total of 121 patients were included in the final analysis (group A 42, group B 40 and group C 39) and evaluated after a mean of 14.8 months follow-up. There was no significant difference (P > 0.05) in hospital stay, time to radiographic union and the incidence of union status among the three groups. Although group C was associated with less secondary procedures versus groups A and B, it was related with more pin tract infections (15.4 %). Anterior knee pain occurred frequently after locking intramedullary nailing (37.5 %) and the irritation symptoms were more frequently encountered in group A (59.5 %). There was no difference in ankle function between the three methods after operation (P > 0.05).

Conclusions

We consider that the minimally invasive plate osteosynthesis, locking intramedullary nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation techniques are all efficient methods for treating distal tibia fractures. With its wide indications, external fixation combined with limited open reduction and absorbable internal fixation leads to minimal soft tissue complication, good functional result and no local soft tissue irritation or implant removal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Im GI, Tae SK (2005) 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 59:1219–1223, discussion 1223

    Article  PubMed  Google Scholar 

  2. Janssen KW, Biert J, van Kampen A (2007) Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop 31:709–714

    Article  PubMed Central  PubMed  Google Scholar 

  3. Vallier HA, Le TT, Bedi A (2008) Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma 22:307–311

    Article  PubMed  Google Scholar 

  4. Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY (2006) Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury 37:531–535

    Article  PubMed  Google Scholar 

  5. Vallier HA, Cureton BA, Patterson BM (2011) Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 25:736–741

    Article  PubMed  Google Scholar 

  6. Braten M, Helland P, Grontvedt T, Aamodt A, Benum P, Molster A (2005) External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients. Arch Orthop Trauma Surg 125:21–26

    Article  PubMed  Google Scholar 

  7. Bach AW, Hansen ST Jr (1989) Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 241:89–94

    Google Scholar 

  8. Borg T, Larsson S, Lindsjo U (2004) Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury 35:608–614

    Article  PubMed  Google Scholar 

  9. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, Mainard D, Vix N, Dehoux E (2010) Distal tibia fractures: management and complications of 101 cases. Int Orthop 34:583–588

    Article  PubMed Central  PubMed  Google Scholar 

  10. Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, Zhang H, Crook N (2012) Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop 36:1457–1462

    Article  PubMed Central  PubMed  Google Scholar 

  11. Larsen LB, Madsen JE, Hoiness PR, Ovre S (2004) Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective, randomized study with 3.8 years' follow-up. J Orthop Trauma 18:144–149

    Article  PubMed  Google Scholar 

  12. Obremskey WT, Medina M (2004) Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists. Orthopedics 27:1180–1184

    PubMed  Google Scholar 

  13. Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84-A:580–585

    PubMed  Google Scholar 

  14. Court-Brown CM, Gustilo T, Shaw AD (1997) Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 11:103–105

    Article  CAS  PubMed  Google Scholar 

  15. Salem KH (2013) Unreamed intramedullary nailing in distal tibial fractures. Int Orthop 37:2009–2015

    Article  PubMed  Google Scholar 

  16. Emami A, Mjoberg B, Karlstrom G, Larsson S (1995) Treatment of closed tibial shaft fractures with unilateral external fixation. Injury 26:299–303

    Article  CAS  PubMed  Google Scholar 

  17. Helland P, Boe A, Molster AO, Solheim E, Hordvik M (1996) Open tibial fractures treated with the Ex-fi-re external fixation system. Clin Orthop Relat Res 326:209–220

    Google Scholar 

  18. Maffulli N, Toms AD, McMurtie A, Oliva F (2004) Percutaneous plating of distal tibial fractures. Int Orthop 28:159–162

    Article  PubMed Central  PubMed  Google Scholar 

  19. Collinge C, Protzman R (2010) Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma 24:24–29

    Article  PubMed  Google Scholar 

  20. Hazarika S, Chakravarthy J, Cooper J (2006) Minimally invasive locking plate osteosynthesis for fractures of the distal tibia–results in 20 patients. Injury 37:877–887

    Article  CAS  PubMed  Google Scholar 

  21. (1996) Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 10 Suppl 1:v-ix, 1–154

  22. Kopp FJ, Banks MA, Marcus RE (2004) Clinical outcome of tibiotalar arthrodesis utilizing the chevron technique. Foot Ankle Int 25:225–230

    PubMed  Google Scholar 

  23. Othman M, Strzelczyk P (2003) Results of conservative treatment of "pilon" fractures. Ortop Traumatol Rehabil 5:787–794

    PubMed  Google Scholar 

  24. Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg (Br) 84:1093–1110

    Article  Google Scholar 

  25. Frigg R (2001) Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). Injury 32(Suppl 2):63–66

    Article  PubMed  Google Scholar 

  26. Drosos G, Karnezis IA, Bishay M, Miles AW (2001) Initial rotational stability of distal tibial fractures nailed without proximal locking: the importance of fracture type and degree of cortical contact. Injury 32:137–143

    Article  CAS  PubMed  Google Scholar 

  27. Sarmiento A, Latta LL (2004) 450 closed fractures of the distal third of the tibia treated with a functional brace. Clin Orthop Relat Res 428:261–271

    Google Scholar 

  28. Bahari S, Lenehan B, Khan H, McElwain JP (2007) Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg 73:635–640

    PubMed  Google Scholar 

  29. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1997) Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 28(Suppl 1):A7–A12

    Article  PubMed  Google Scholar 

  30. Aksekili MA, Celik I, Arslan AK, Kalkan T, Ugurlu M (2012) The results of minimally invasive percutaneous plate osteosynthesis (MIPPO) in distal and diaphyseal tibial fractures. Acta Orthop Traumatol Turc 46:161–167

    Article  PubMed  Google Scholar 

  31. Cheng W, Li Y, Manyi W (2011) Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation. Int Orthop 35:737–742

    Article  PubMed Central  PubMed  Google Scholar 

  32. Hasenboehler E, Rikli D, Babst R (2007) Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury 38:365–370

    Article  CAS  PubMed  Google Scholar 

  33. Lau TW, Leung F, Chan CF, Chow SP (2008) Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop 32:697–703

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Blauth M, Bastian L, Krettek C, Knop C, Evans S (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 15:153–160

    Article  CAS  PubMed  Google Scholar 

  35. Leung F, Kwok HY, Pun TS, Chow SP (2004) Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35:278–283

    Article  PubMed  Google Scholar 

  36. Zou J, Shi ZM, Zhang W, Zhang CQ (2012) Open reduction and internal fixation better than percutaneous plate osteosynthesis in distal tibial fractures. J Invest Surg 25:326–329

    Article  PubMed  Google Scholar 

  37. Keating JF, Orfaly R, O'Brien PJ (1997) Knee pain after tibial nailing. J Orthop Trauma 11:10–13

    Article  CAS  PubMed  Google Scholar 

  38. Karladani AH, Styf J (2001) Percutaneous intramedullary nailing of tibial shaft fractures: a new approach for prevention of anterior knee pain. Injury 32:736–739

    Article  CAS  PubMed  Google Scholar 

  39. Cavusoglu AT, Er MS, Inal S, Ozsoy MH, Dincel VE, Sakaogullari A (2009) Pin site care during circular external fixation using two different protocols. J Orthop Trauma 23:724–730

    Article  PubMed  Google Scholar 

  40. Busam ML, Esther RJ, Obremskey WT (2006) Hardware removal: indications and expectations. J Am Acad Orthop Surg 14:113–120

    PubMed  Google Scholar 

  41. Podeszwa DA, Wilson PL, Holland AR, Copley LA (2008) Comparison of bioabsorbable versus metallic implant fixation for physeal and epiphyseal fractures of the distal tibia. J Pediatr Orthop 28:859–863

    Article  PubMed  Google Scholar 

  42. Zhao L, Li Y, Chen A, Zhang Z, Xi J, Yang D (2013) Treatment of type C pilon fractures by external fixator combined with limited open reduction and absorbable internal fixation. Foot Ankle Int 34:534–542

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Trauma Surgery, Orthopaedic Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China

    Yongchuan Li, Qinghe Guo, Lei Zhu, Tianwen Ye & Aimin Chen

  2. Department of Orthopaedic Surgery, The 85th Hospital of PLA, 1328 Huashan Road, Shanghai, China

    Xi Jiang

Authors
  1. Yongchuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xi Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qinghe Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tianwen Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aimin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aimin Chen.

Additional information

Yongchuan Li, Xi Jiang and Qinghe Guo contributed equally to this work.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Li, Y., Jiang, X., Guo, Q. et al. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. International Orthopaedics (SICOT) 38, 1261–1267 (2014). https://doi.org/10.1007/s00264-014-2294-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2294-1

Keywords

search

Navigation