Comparative Study of Locking Plate Fixation versus Intramedullary Nail Fixation for a Displaced Extra Articular Fracture of Distal Tibia in Adults
Abstract
Tibial fractures are the most common long bone fracture. Among tibial fractures distal tibial fractures are quite common. There are many modalities tried to manage distal tibial fractures. This study was conducted on 60 distal tibial fracture cases to compare results of Intramedullary Nail Fixation (IMNF) and Distal Tibia Locking Compression Plate Fixation (DTLCPF) for Displaced Extra Articular Fracture of Distal Tibia in Adults. It was found that in intramedullary nail (IMNF) group full mean weight wearing time was significantly lesser than DTLCPF i.e. 7.70 weeks in IMNF group and 14.87 weeks in DTLCPF group. Mean time at which visible callous was seen was also lesser in IMNF group than DTLCPF i.e 9.30 weeks v/s 11.90 weeks. Mean time of union was without significant difference i.e. 16.13 weeks in IMNF and 17.43 weeks in DTLCPF. Mean value of DRI score is 13.00 in IMNF and 17.53 DTLCPF group. Complication rate was similar (16.67%) in both the groups. Although infections are more in IMNF group and mal-union was more in DTLCPF group but type of complication were no varies with significant difference. According to Johner and wruh’s criteria IMNF group 76.66% had good results whereas in DTLCPF 83.33% had good results which was without significant difference. It can be concluded from study that both procedure manage these type of fractures and results are well comparable without significant difference.
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Introduction
Tibial fractures are the most common long bone fracture and occur at a frequency of about 26 fractures per 100,000 populations per year. They are approximately three times more common in males and are usually due to high energy trauma such as motor vehicle accidents. The frequency of their occurrence increases again later in life with the development of osteopenia and osteoporosis.1
Fractures of the distal third tibia are unique in that the bone is subcutaneous with depleted muscular cover; the consequent decreased vascularity leads to complications like delayed bone union, wound complications such as dehiscence and infection.
The presence of hinge joints at the knee and the ankle allows no adjustment for rotary deformity after fracture, and special care is necessary during reduction to correct such deformity. Delayed union, nonunion, and infection are relatively common complications of distal tibial fractures.
Non-operative treatment now is generally reserved for closed, stable, isolated, minimally displaced fractures caused by low-energy trauma and some stable low-velocity gunshot fractures
Conclusion
It was concluded from this study that although partial and full weight bearing was earlier in IMNF than DTLCPF but union time was without significant difference in both the groups. Likewise DSI score and Johner and wruh’s criteria wise also both procedures were comparable.