Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures

Purpose

The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures.

Methods

Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed.

Results

The mean followed-up was 24.7?±?2.7 months in group A and 25.8?±?2.8 months in group B. No patient had nonunion, shortening, hardware breakdown, or deep-seated infection. Patients in group A had a significantly shorter mean operating time, hospital stay, full weight-bearing time and union time (76?±?16.6 vs. 90?±?20.3 minutes, p?=?0.000; 5.8?±?2.1 vs. 8.9?±?3.1 days, p?=?0.000; 9.0?±?1.4 vs. 11.1?±?1.7 weeks, p?=?0.000; and 21.3?±?3.5 vs. 23.1?±?3.6 weeks, p?=?0.047, respectively). Three patients in group A and one patient in group B presented with malalignment (p?=?0.608). The mean Olerud-Molander Ankle score was 89.0?±?7.1 in group A and 87.6?±?8.4 in group B (p?=?0.478).

Conclusions

Distal tibia metadiaphyseal fractures may be treated successfully with low, multidirectional locked nails or plates. However, low, multidirectional locked nailing may represent a superior surgical option, since it offers advantages in terms of mean operating time, hospital stay, full weight-bearing time and union time.