Background: Distal tibia metaphyseal extra articular fractures are associated with great dilemma for operating surgeon. It is associated with high rate of delayed and non-union due to precarious blood supply and less muscle coverage. Has poor outcomes and high complication rates. Although multiple treatment modalities are described to treat these fractures, there is no consensus on the best method of treatment. We hereby want to evaluate the outcome of metaphyseal extra articular tibia fractures treated by plating and intramedullary nailing.
Methods: This study was undertaken in patients who were operated in between October 2015 to January 2018 at Dr. Ulhas Patil medical college and hospital Jalgoan Maharashtra. Study included 39 patients with distal tibia metaphyseal extraarticular fracture treated by surgery. All the fractures were closed. Twenty four patients underwent expert tibia nailing whereas 15 patients were treated by locking plates. Patients were followed up at 6 weeks, 12 weeks, 4.5 months, 6 months and 9 months with x-rays.
Results: Thirty nine patients included in study and they were divided into two groups as nailing group and plating group. Plating group included 15 patients whereas nailing group included 24 patients. The mode of injury was road traffic injury in 27 cases, followed by self-fall in 9 cases and sports related injury in 3 cases. The average duration of surgery in nailing was group was 70 minutes (range, 60-130 minutes) whereas average duration of surgery in plating group was group was 88 minutes (range, 80-130 minutes). Average distance of fracture from articular surface was 6 cm in nailing group and 4 cm in plating group. The average time for union was 13.5 weeks for nailing group and for plating group it was 17 weeks.
Conclusions: Both intramedullary nailing and plating are the optimal methods of treatment. Plating is preferred in cases where fracture is close to articular area but requires more time than intramedullary nailing. There is little early union rate for nailing of 13.5 weeks as compare to plating of 17 weeks. Complication rates of plating like infection and wound complication are more than nailing because plating is open procedure than closed nailing procedure. Rest complication are comparable.