The best modality of management of distal tibial fractures (extra articular) remains controversial and challenging. Various studies have shown varying results with different modalities of treatment, however our study is to compare functional and radiological outcomes between patients treated with tip locking nail and compression plate using MIPP0 Technique. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the tibial midshaft fractures.
Material and methods: A total of 120 patients between the age of 25-50 years were treated randomly with nailing (Group A) and percutaneous plating (Group B) between the year May 2014- March 2017. At one year follow up, outcome was analysed based on union rate, operating time, complications (Infections, Nonunion, delayed union, malunion) and functional score by AOFAS (American orthopedic foot and ankle score). 53 patients included in group A and 55 patients in group B. 12 patients did not follow up.
Result: Out of 108 patients randomly, average operating time in nailing is 44.21 mins and plating is 40.14 mins. 1 patient in group B developed superficial infection which healed well on long term follow up. In 30 patients, fibula fracture was first fixed using 3.5mm one third tubular plate and cortical screws due to ankle joint/syndesmotic instability. Mean radiological union time in nailing group was 20.1 weeks. (18-22 weeks) and plating group was 17.5 weeks (16-18 weeks). 4 cases in nailing developed malunion with angulation less than 5 degree which was acceptable and 2 cases developed varus deformity with angulation more than 5 degree. No cases of implant failure was noted. No evidence of nonunion was noted in both groups. Functional outcomes based on AOFAS score was IM nailing 90.8 and 96.2 for plating which was statistically significant between the 2 groups. In addition to pain which was included in AOFAS score 10 patients treated with IM nailing had anterior knee pain.
Conclusion: Based on the above study, we concluded that treating distal tibia fractures (extraarticular) with locking compression plate using MIPPO technique is superior than tip locking nail as there is better anatomical reduction/alignment leading to quicker radiological union and better functional outcome according to AOFAS.