Comparative study of distal tibia fractures managed by nailing vs plating

Introduction: Distal tibia fractures often caused by high energy axial compressive, direct bending or low energy rotation forces. These fractures constitute less than 7% of all the tibial fracture and less than 10% of all lower extremity fractures. Management of distal tibia fracture is challenging because of its subcutaneous location with precarious blood supply, proximity to the ankle joint and associated soft tissue injury. Numerous features are responsible for this, but perhaps none are as difficult as the accompanying soft tissue injury that is frequently present. They are associated with gross swelling, skin injury and blisters because of subcutaneous location. Skin condition determines the timing of surgery. The aim of treating the fracture is to preserve normal mechanical axis, ensure joint stability and restore a near full range of motion. This is a difficult task to accomplish in each and every case as we face compromised soft tissue condition and variable bone quality. Available options for stabilizing fractures are closed reduction and intramedullary interlocking (IMIL) nailing or open reduction and internal fixation (ORIF) with plating or closed reduction and percutaneous plating (MIPPO) or external fixators. The factors determining the fixation methods are pattern of fracture, quality of bone and condition of soft tissues. In our study, we are trying to evaluate and compare the results of fixation of distal tibia fractures with different modalities of treatment. Aim: To compare the outcome of fracture distal tibia managed by various modalities. Materials and Methods: This was a prospective study conducted in Department of Orthopaedics in Tertiary care hospital attached to a Medical college between July 2014 and June 2016.The study consisted of 30 consecutive patients with Distal tibia fracture managed surgically with either Intramedullary interlocking nailing (IMIL) or Open reduction and internal fixation (ORIF) or Minimally invasive percutaneous plating (MIPPO) or External fixation. Patients with open fractures were graded using the Gustilo Anderson classification for open fractures. All 30 patients were followed-up for clinical evaluation using The American Orthopedic Foot and Ankle Society (AOFAS) score and Functional score of Olerud and Molander and Clinico-Radiological evaluation at 1 month, 2 months, 3 months, 6 months. Results and Discussion: In our study, patients were divided as Group I including the patients managed primarily by closed reduction and intramedullary nailing and Group II including patients managed primarily by plating. In this study in patients of Group I, 73.33% (11) had excellent results, 13.33%(1) had good and 13.33% (2) had poor results as per our scoring system of AOFAS and Olerud & Molander score. In patients of Group II, 60% (9) had excellent results, 20% (3) had good, 20% (3) had fair results as per our scoring system of AOFAS and Olerud & Molander score. Conclusion: Due to small number of patients involved in our study, we cannot draw any definitive conclusions from our preliminary results but view them as valuable basis for further studies. Further research is necessary, in order to evaluate whether this surgical technique in long term provides us with the safe and effective management options for distal tibia fractures.