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
Related Articles
- EP ID EP474712
- DOI -
- Views 101
- Downloads 0
Clinico Microbiological Spectrum of Diabetic Foot Infections
Abstract: Diabetic foot infections are a common cause of morbidity and mortality. This study was undertaken to study the microbiological flora of diabetic foot ulcers and to assess the in vitro antibacterial susceptibili...
Imprint Cytology for Early Diagnosis of Prostate Cancer
Abstract:Although the diagnosis of BPH (Benign Prostatic hyperplasia) is not difficult but the presence of early carcinoma often goes undetected. Thus imprint cytology becomes immensely valuable by helping in early and a...
Asymptomatic Bacteriuria among antenatal Women Attending private Hospital in Lagos, Nigeria
Pregnant women are at increased risk for UTIs as a result of decline in immunity appears to promote the growth of both commensal and non-commensal microorganisms. A total of 140 mid-stream urine samples were collected fr...
A Descriptive study of residual hypertension and biochemical changes following post-partum period of pre-eclampsia & eclampsia presenting women
Hypertensive disorders of pregnancy poses a challenge for the treating doctors. They usually resolve after delivery but sometime may persists. The objective of this study is to find out residual hypertension & biochemica...
Clinico-Pathological Study of Oral Submucous Fibrosis and Its Correlation with Oral Cancer
Abstract: Sub mucous fibrosis is an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. The letter sub epithelial and sub mucous fibrosis leads to stiffness of the oral mucosa and d...