Abstract: Background: Tibial fractures are the most common long bone fractures, while distal tibial fractures are even more complicated due to their proximity to the ankle and the close relationship with thin, soft tissue envelope and severe comminution.
Objectives: To assess and compare fractures' functional outcomes in Group A (treated with plating) versus Group B (treated with intramedullary nailing). To assess the efficacy, advantages, and disadvantages of the treatment modalities and their complications.
Materials and Methods: This is a comparative study done from October 2019 to March 2021 in the Department of Orthopaedics, Narayana general hospital, attached to Narayana Medical College, Nellore. In this study period total of 40 patients were taken for study as per inclusion criteria. The patients are randomized into two groups of 20 cases each. Group A treated with plating, and Group B was treated with intramedullary nailing.
Results: In our study, good results were observed in Intramedullary nailing groups (51.43%) when compared with the plating group (40.3%). These differences were statically significant with a p-value (p<0.05). The mean Olerud and Molander functional score at the end of 1 year was higher for the intramedullary interlocking nail group (81.6) as compared to that for the plating group (74.4). The average duration for the radiological union in the intramedullary interlocking nail group was 20.1 ± 1.14 weeks (range 18-22 weeks), and in the plating group, it was 24.1 ± 1.16 weeks (range 22-30 weeks). Thus, the union occurred significantly faster in the nailing group (P-value 0.001). Three patients from the plating group had delayed union. In this study, a significantly better ankle range of motion was noticed in the intramedullary interlocking nail group as compared to that of the distal tibia plating group. Average dorsiflexion at the final follow-up (12 months) was 11.8 degrees and 8.7 degrees in the intramedullary interlocking nail group and the distal tibia plating group, respectively(P value<0.025). The average plantar flexion was 30.6 degrees and 23.7 degrees in the intramedullary interlocking nail group and the distal tibia plating group, respectively (P value< 0.001).
Conclusion: Intramedullary nailing has the advantages of shortened operating time, early weight-bearing (partial and full), decreased wound problems, an early union of the fracture, decreased implant-related problems, and overall reduced morbidity. Intra-medullary interlocking nail is a good and satisfactory method for the treatment of AO 43 a type distal tibia fractures.
