Surgical dilemma’s in treating distal third leg fractures
Keywords:Minimally invasive, Intramedullary nailing, Distal third tibia
Background: Of all the long bones, the tibia and fibula have the highest incidence of fractures. These fractures are often caused by high energy trauma. The management of tibial fractures has always been particular interest to orthopaedic surgeons because they are relatively common but difficult to treat. The spectrum of injuries to the tibia is so diverse that there is no single method of treatment applicable to all fractures. In this we are going to analyse distal tibia fracture treated by nailing and minimally invasive plate osteosynthesis.
Methods: A prospective study done at Sri Ramachandra Medical Centre between June 2011 and June 2013. The inclusion criteria were closed extra - articular distal third tibia fracture. The exclusion criteria were compound fractures, intraarticular fractures, paediatric fractures and pathological fractures. We had fifteen patients who underwent closed intramedullary interlocking nail and fifteen patients treated with plate osteosynthesis (MIPO).
Results: All the fractures united solidly with mean union time of 24.5 weeks ranging from 18 to 38 weeks. The patient who underwent nailing showed mean healing time of 24.9 weeks which has not shown any significant advantage over the healing time of patients treated with plate osteosynthesis by MIPO technique which is 24.2 weeks. In nailing group the infection rate was 20% which is significantly higher when compared to patients who were treated with plate osteosynthesis 6.6%.
Conclusion: Plate osteosynthesis by minimally invasive technique and intramedullary interlocking nailing are equally effective methods of stabilisation for distal tibia fracture when considering the union rates and final functional outcome. However malunion, nonunion and secondary procedures were more frequent after intramedullary interlocking nail. Concurrent fibula fixation with plate osteosynthesis will minimise the incidence of malunion for distal tibia fractures.
Ronga M, Longo UG, Maffulli N. Minimally invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res. 2010 Apr;468(4):975-82.
Bhandari M, Guyatt GH, Tornetta P, Swiontkowski MF, Hanson B. Current practice in the intramedullary nailing of tibial shaft fractures: an international survey. J Trauma. 2002 Oct;53(4):725-32.
Klemm KW, Borner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;212:89-100.
Resch H, Pechlaner S, Benedetto KP. Long term results after conservative and surgical treatment of fractures of the distal end of tibia. Aktuelle Traumatol, 1986;16:117-23.
Heather. A. Vallier, Toan Le. Radiographic and clinical comparison of distal tibia shaft fractures plating vs. intramedullary nailing. J Orthop Trauma. 2008 May/Jun;22(5):307-11.
Cheng-yu Fan, Chao-Ching Chiang. Interlocking nails for displaced metaphyseal fractures of distal tibia. Injury. 2005;36:669-74.
Cory Collinge, Mark Kuper, Robert Protzman. Minimally invasive plating of high energy Metaphyseal distal tibia fractures. J Orthop Trauma. 2007 Jul;21(6):355-61.
Cory Collinge, Robert Protzman. Outcome of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010 Jan;24(1):24-9.
Dorga AS, RuizAL, Thompson NS, Nolan PC. Dia-metaphyseal distal tibial fractures -treatment with a shortened intramedullary nail: a review of 15 cases. Injury. 2000 Dec;31(10):799-804.
Egol KA, Weisz R, Hiebert R, Tejwani NC, Koval KJ, Sanders RW. Does fibular plating improve alignment after intramedullary nailing of distal tibia metaphyseal fractures? J Ortho Trauma. 2006 Feb;20(2):94-103.
Gun-II Im, Sue-Kee Tae. 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. 2005 Nov;59(5):1219-23.