A Comparative Study of Intramedullary Nailing Versus Plating in Fracture Tibia and Fibula
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 3
Abstract
Abstract: Malalignment has been frequently reported after intramedullary stabilization of distal tibia fractures. Nails have also been associated with knee pain in several studies. Historically, plate fixation has resulted in increased risks of infection and non-union. Our purposes were to compare plate and nail stabilization for distal tibia shaft fractures by assessing complications and secondary procedures. We hypothesized that nails would be associated with more malalignment and non-union. 68 patients with extra-articular distal tibia shaft fractures with a mean age of 38 years (range, 18-95 years) and mean Injury Severity Score of 13.5 were included in this study. Patients were randomized to a reamed intramedullary nail (n =34) or a large fragment medial plate (n = 34). Forty fractures (39%) were open. Twenty-eight (27%) had concomitant fibula fractures that were stabilized. Outcomes like Mansion, non-union, infection, and secondary operations were measured Eighty-three percent of infections occurred in open fracture (P < 0.001). Four patients (7.1%) developed non-union after nailing versus two (4.2%) after plating (P = 0.25) with a trend for non-union in patients who had distal fibula fixation (12% versus 4.1%, P = 0.09). All non-union occurred after open fracture (P = 0.0007); the primary union rate for closed fractures was 100%. Primary angular malalignment of 5° or greater occurred in 13 patients with nails (23% of all nails) and four with plates (8.3% of all plates; P = 0.02 for plates versus nails). Six additional patients experienced malalignment after immediate weight bearing against medical advice. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (55%, P = 0.04). Eighty-five percent of patients with malalignment after nailing did not have fibula fixation. Eleven patients underwent 15 secondary procedures after plating, five of which were for prominent implant removal. This was not significantly different from patients treated with nailing: 10 patients had 14 procedures and five for prominent implant removal. High primary union rates were noted after surgical treatment of distal tibia shaft fractures with both no locked plates and reamed intramedullary nails. Rates of infection, non-union, and secondary procedures were similar. Open fractures had higher rates of infection, non-union, and mansion. Intramedullary nailing was associated with more malalignment versus plating.
Authors and Affiliations
Dr. Rabi Narayan Dhar, Dr. Pradeep Kumar Merli, Dr. Rashmi Ranjan Dash
Keywords
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