Abstract: Background: Distal tibial fractures account for approximately 7% of all tibial fractures and can present a management challenge because of their inherent instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone. Despite the availability of various modern techniques, there is either no or insufficient evidence to draw definitive conclusions on the best surgical intervention.
Materials and Methods: The study was an open labelled randomized control trial conducted over a period of one year from January to December 2017. Patients with extra-articular distal tibia fracture attending the Department of Orthopaedics, in tertiary care hospital through casualty or outpatient basis fulfilling the inclusion and exclusion criteria were the study participants. After obtaining necessary permissions and consent, the patients were randomized into two groups for IMIL nailing and plating. Data on socio-demographic characteristics, surgery details and complications were obtained. The functional outcomes were measured at 1, 3, 4, and 6 months by using Olreud & Molander scale and RUST scale. The data obtained were entered into excel and analyzed using SPSS v16.
Results: A total of 32 patients (16 in each group) participated. The mean age of participants were 44.1 (±16.95) years and majority were males (56.3%). Majority (81.3%) patients had an associated fracture in the distal fibula. The time of surgery and fracture union for intramedullary nail was significantly less when compared to plating. The Olreud & Molander scores and RUST scores were significantly higher in patients with IMIL nail. Malunion and anterior knee pain were more frequent after IM interlocking nail. Non-union and infection were found only in the plating group.
Conclusion: The study found intra-medullary inter-locking (IMIL) nailing was more successful and effective in terms of achieving good union with optimal functional outcomes compared to the extra medullary plating for closed extra-articular distal third tibial fractures. A larger sample size with equal representation in both groups is required for a p value with higher significance.
