Distal tibia fractures continue to be one of the most controversial fractures that we treat. The best option for surgical treatment of distal tibia fractures is still unclear. Aim of treating such fracture is to produce a stable construct which allows early mobilisation and weight-bearing, but with minimal complications.
Material and methods: We studied 50 patients with distal tibia fractures within two Muller squares of ankle joint. 25 each treated with Intramedullary Interlocking nail (Nailing group) and distal tibia locking plate (Plating group). The study was prospective and comparative for the methods used for management of fracture. Outcomes in terms of union, time to full weight bear, alignment, infection, secondary procedure required and functional outcome at one year follow up were measured and compared.
Results: Age range of patients was 18-75 years. Most common mode of trauma in both groups was road traffic accident (60%) followed by domestic accidents (40%). Time after which full weight bearing was started were significantly shorter in Nailing group (p=0.001). The average time for union was 19.1 weeks (19-22 weeks) in Nailing group and 23.8 weeks for Plating group (22-30 weeks), (p=0.001). Average dorsiflexion at the final follow-up in nailing group was 12.6 degrees and 9.6 degrees in plating group (p=0.025). Average plantar flexion at the final follow-up in nailing group was 32.4 degrees and 25.0 degrees in plating group (p=0.001). Infection was found in 28% of patients in plating group with 12% of patients undergoing secondary surgical procedure. Mal-alignment was found in 4% of patients in Nailing group. The mean functional score in nailing group was found to be better as compared to plating group.
Conclusion: We conclude that intra-medullary interlocking nail is a reliable and satisfactory method for the treatment of 43 A type distal tibia fractures with good functional results and high union rates with comparatively low complications.