Treatment of Fracture Distal Tibia by Distal Tibial Locking Plate Verses Interlocking Nail: A Prospective Comparative Study

ABSTRACT

Introduction: Fractures of distal third of tibia pose greaterchallenge to the treating surgeon, in view of its relative lack ofvascularity, as it is devoid of muscular envelope and is coveredonly by skin and tendons. Its proximity to the ankle joint makesit further complex than any diaphyseal fracture. A variety oftreatment modalities are available including non operative,external fixation, IM nailing and plating. Whereas, closedreduction and casting is known for redisplacement withresultant malunion and joint stiffness because of prolongedimmobilisation, external fixators are of utility only for compoundfractures of mid third and are known for pin track infections.Material and Methods: A Comparative prospective study oftwo procedures, for displaced fractures of distal third tibia inadults was conducted in Govt. Medical College (GMC),Jammu. 30 patients (Group A) were treated by ClosedReduction and fixation with IMIL Nailing and another 30 (GroupB) were treated by closed reduction and fixation using DistalTibial Locking Plate with MIPPO Technique. The patients werefollowed for a minimum of one year wherein the clinicalparameters, radiological progress and final functional resultswere evaluated as per American Orthopaedic Foot and AnkleSociety Score (AOFAS).Results: There was no significant difference in fracture healingtime or ambulation time. Good to Excellent results of 60% werefound in Group A and 73.3% in Group B. There were 13.3% ofpoor results in Group A as compared to 6.7% of Group B.Overall complication rate was higher in Group A. IMIL Nailinghad to be abandoned in 2 cases (6.7%) and switched on toDTLCP, due to per operative finding of medullary canal beingnarrower than 8 mm in one and curved in another. IMIL GroupA, also had 2 cases (6.7%) bent nail, 2 cases (6.7%) brokennail and another 3 cases (10%) of bent/broken locking bolts.No such implant related complications were observed inGroup B.Conclusion: IMIL Nailing is a technically demandingprocedure, requiring a thorough pre- operative work up and askilled experienced surgeon with all sizes of nails, reamers andalternative options available before contemplating it. However,DTLCP by MIPPO technique is easier to learn, is equallybiological, based on sound AO principles of indirect reductionand stabilization by extra periosteal fixed angle construct. Theprocedure has fewer per operative and postoperativecomplications and gives comparable or better results than IMILNailing. The choice of the procedure should be guided by thesite and geometry of fracture and individual experience of thetreating surgeon.