Extra-articular distal tibia fractures—controversies regarding treatment options. A single-centre prospective comparative study
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Distal tibia fractures are reported to have a high complication rate pre-operatively as well as post-operatively, which can include open fractures, soft tissue damage, infection, malalignment, pseudarthrosis and ankle arthrosis. The operative treatment for the extra-articular distal tibia fractures is a controversial topic in the orthopaedic literature. Some of these fractures are proximal enough to be treated with an intramedullary nail while others are too distal for that. The aim of our study was to compare the results we have had with intramedullary nail (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal metaphyseal (extra-articular) tibia fractures. The study was designed prospectively between January 2013 and March 2016 and took place on the Orthopaedics and Traumatology ward of a Clinical Emergency County Hospital in western Romania. The follow-up visits were scheduled one month, three months and six months post-operatively. For evaluating the ankle function, we used the Olerud–Molander ankle score (OMAS) and union was evaluated at six months on ankle X-rays. At the six-month follow-up visit the average scores were 75.55 (20-100) for the IMN lot and 74.23 (20-90) for the MIPO lot, without finding any statistical difference between the two groups (p >0.1). At the six-month follow-up, X-ray union was objected in 48 (90.5%) of our patients, the IMN lot having worse results (85.18%) than the MIPO lot (96.15%). The results we encountered showed little to no statistical difference when it comes to the functional score we used (OMAS score), leading us to believe that you can achieve comparable results with both implants.
KeywordsDistal tibia fracture Intramedullary nail MIPO plating Functional outcome Complication rates
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
All procedures performed in this study were in accordance with the ethical standards of the SCJU Pius Branzeu Research Committee and with the 1964 Helsinki declaration and its later amendments.
- 2.Deleanu B, Prejbeanu R, Tsiridis E, Vermesan D, Crisan D, Haragus H, Predescu V, Birsasteanu F (2015) Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center. World J Emerg Surg 10:55. https://doi.org/10.1186/s13017-015-0049-y CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Kuo LT, Chi CC, Chuang CH (2015) Surgical interventions for treating distal tibial metaphyseal fractures in adults. Cochrane Database Syst Rev 3:Cd010261Google Scholar
- 12.Wagner M, Frigg R (2006) AO manual of fracture management—internal fixators: concepts and cases using LCP/LISS. Thieme Publishing Group, Nederlands Tijdschrift voor TraumatologieGoogle Scholar
- 18.Zou J, Shi Z-M, Zhang W, Zhang C-Q (2012) Open reduction and internal fixation better than percutaneous plate osteosynthesis in distal tibial fractures. J Invest Surg Informa Healthcare USA 25(5):326–329Google Scholar
- 19.Predescu V, Jinescu G, Olaru RI, Prescura C, Deleanu B (2016) Study of the tranexamic acid on blood loss in arthroplasty. RevChim 67(8):1513–1515Google Scholar
- 21.Hoegel FW, Hoffmann S, Weninger P, Bühren V, Augat P (2012) Biomechanical comparison of locked plate osteosynthesis, reamed and unreamed nailing in conventional interlocking technique, and unreamed angle stable nailing in distal tibia fractures. J Trauma Acute Care Surg 73(4):933–938CrossRefPubMedGoogle Scholar
- 22.Kuhn S, Appelmann P, Mehler D, Pairon P, Rommens PM (2014) Retrograde tibial nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures. J Orthop Surg Res Bio Med Central Ltd 9(1):35Google Scholar
- 23.Sala F, Thabet AM, Capitani P, Bove F, Abdelgawad AA, Lovisetti G (2017) Open supracondylar-intercondylar fractures of the femur treatment with Taylor spatial frame. J Orthop Trauma 31(10):546–553 doi. https://doi.org/10.1097/BOT.0000000000000923
- 26.Predescu V, Prescura C, Olaru R, Savin L, Botez P, Deleanu B (2017) Patient specific instrumentation versus conventional knee arthroplasty: comparative study. Int Orthop 41(7):1361–1367Google Scholar