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Knee and ankle function after displaced non-isolated fractures of the tibial shaft, a retrospective comparison between plate fixation and intramedullary nailing

  • Hossein Khatibi
  • Ali Akbar Esmaili Jah
  • Mohammad Mehdi Sar Zaeem
  • Ali Kalhor MoghaddamEmail author
Original Article
  • 162 Downloads

Abstract

Knee and ankle function after tibial shaft fractures have not been evaluated comparing intramedullary nailing (IMN) and plate fixation (PF). In a retrospective case review study we evaluated 50 patients with history of closed tibial and fibular shaft fracture who have been treated by IMN or PF from 1999 to 2003. Twenty-five patients in each group evaluated for knee and ankle function using Iowa knee score, ankle rating score and VAS for the pain. 18.3±4.8 weeks after PF (mean follow up 35±11.7) and 16.4±4.6 weeks after IMN fixation (mean follow up 36.8±11.3) union has been achieved (P<0.17). The knee score was 89.4±10.4 in IMN group and 95.7±6.7 in PF one (P<0.01). The ankle rating score was 94.7±7.2 in IMN and 96.8±6.1 in PF (P<0.28). The nail to knee distance (average 14±5.2 mm) was significantly correlated to the knees’ function and pain (r=0.599, P<0.002, r=0.583, P<0.002, respectively). T-test reveals that knees’ function are significantly inferior with transpatellar approach in comparison with parapatellar one (86.1±10.6 vs. 95.3±7.4, P<0.01). Our study discloses that using plate may lead to better knee function, while IMN causes higher amount of knee pain with controversial reasons.

Keywords

Tibial shaft fracture Knee pain Ankle pain Intramedullary nailing Fracture fixation Function 

Résumé

Le but du travail est de comparer la fonction des articulations du genou et de la cheville après enclouage ou fixation par plaque des fractures de jambe. Matériel et Méthodes. Dans un travail rétrospectif nous avons étudié 50 patients ayant présenté une fracture fermée de la diaphyse des deux os de la jambe, traitée par enclouage centromédullaire ou ostéosynthèse par plaque entre 1999 et 2003. La fonction du genou et de la cheville a été évaluée pour les 2 groupes de 25 patients sur la base du score Iowa pour le genou, du score cheville, et d’une échelle visuelle analogique pour la douleur. Résultats. La consolidation a été acquise à 18,3 ±4,8 semaines dans le groupe plaque (recul moyen 35±11,7) et 16,4±4,6 dans le groupe enclouage (recul moyen 36,8±11,3). Le score genou est de 89,4±10,4 dans le groupe enclouage et 95,7±6,7 dans le groupe plaque (p<0,01). Le score cheville est de 94,7±7,2 dans le groupe enclouage et 96,8±6,1 dans le groupe plaque (p<0,28). La distance clou interligne articulaire (moyenne 14±5,2) est significativement corrélée à la fonction du genou (r=0,599, p<0,002), et à la douleur (r=0,583,p<0,002). La fonction du genou est significativement inférieure dans les abords trans-patellaires par rapport aux abords para-patellaires. Conclusion Notre étude révèle que l’ostéosynthèse par plaque donne une meilleure fonction du genou alors que l’enclouage centromédullaire cause un plus grand nombre de douleurs du genou pour des raisons controversées.

Mots clés

fracture diaphyse tibiale douleur genou douleur cheville enclouage centromédullaire ostéosynthèse fonction 

Notes

Acknowledgement

We declare that current experiment comply with the Iranian medical laws. No benefits in any form have been received from a commercial party related directly or indirectly to the subject of this manuscript.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hossein Khatibi
    • 1
  • Ali Akbar Esmaili Jah
    • 2
  • Mohammad Mehdi Sar Zaeem
    • 1
  • Ali Kalhor Moghaddam
    • 2
    Email author
  1. 1.Emam hosein University HospitalShahid Beheshti medical UniversityTehranIran
  2. 2.Akhtar University HospitalShahid Beheshti Medical UniversityTehranIran

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