Vol. 11, Issue 4 (2025)

Introduction: Distal tibial fractures, particularly those involving the tibial plafond or pilon region, are challenging due to their anatomical complexity, limited soft tissue envelope, and proximity to the ankle joint. High-energy trauma such as road traffic accidents or falls from height are common causes. Traditional management methods like casting or intramedullary nailing often lead to complications such as malalignment, non-union, or joint stiffness. Locking compression plating (LCP), particularly via the medial approach, offers improved stability, anatomical reduction, and preserves fracture biology, making it a valuable surgical option.

Aim: To assess the functional outcome of medial distal tibia locking compression plate fixation in distal tibia fractures.

Objective

•    To assess postoperative functional outcomes of the ankle joint.
•    To evaluate postoperative complications.
•    To analyze clinical and radiological outcomes using standard scoring systems.
Methodology: This prospective comparative study was conducted on patients with closed tibial shaft fractures who were treated using either suprapatellar or infrapatellar nailing techniques. Patients were randomly allocated into two groups. Standard preoperative, intraoperative, and postoperative protocols were followed. Variables such as operative duration, radiation exposure, VAS for knee pain, and postoperative alignment were recorded. Functional outcomes were assessed at regular intervals using the AOFAS score and Johner & Wruhs criteria. Data were analyzed using SPSS version 26.

Results: Most patients (53.7%) were aged 30-60 years, with a male predominance (61%). Falls were the leading cause of injury (68.3%). The right side was more commonly affected (73.2%). Majority (63.4%) had Gustilo-Anderson Grade II fractures. Mean fracture union time was 18.07 weeks. Fibula fixation was performed in 87.8% of cases. Pain scores significantly decreased over time. Postoperative complications included delayed union (9.8%), infection (7.3%), and rare cases of malunion or nonunion (2.4% each). Radiological outcomes were excellent in 68.3% and good in 22%. Functionally, 73.2% of patients had excellent results per AOFAS score, with 19.5% good and 7.3% fair outcomes.

Discussion: The study demonstrated that medial distal tibia LCP fixation provides favorable clinical and functional outcomes in managing distal tibial fractures. Early mobilization, minimal soft tissue disruption, and strong construct stability contributed to effective recovery. Compared to other modalities like external fixation or intramedullary nailing, the locking plate showed fewer complications and better union rates. Literature supports that MIPO (Minimally Invasive Plate Osteosynthesis) with LCP offers biomechanical and biological advantages, preserving blood supply and reducing infection risks. However, soft tissue management remains critical to avoid wound complications.

Conclusion: Medial distal tibia locking compression plate fixation is a reliable and effective treatment for distal tibia fractures. It offers excellent radiological alignment and functional outcomes with minimal complications when applied judiciously. This method supports early mobilization, rapid recovery, and is particularly beneficial in cases unsuitable for intramedullary fixation. Future studies with larger cohorts and longer follow-up are recommended to further validate these findings.