Comparison of radiological and clinical outcomes of patients treated with plating versus IMIL nailing in distal tibia fractures: A prospective study

Abstract

Background: Distal tibia fractures account for less than 10% of all lower extremity fractures. Tibial fractures are frequently accompanied by soft tissue damage, thus if they are not correctly treated, they can significantly impair the patient. Various surgical modalities used for these fractures include closed intramedullary nailing, plating by open or closed methods, and several types of external fixators. Our study's objective was to evaluate the effectiveness of locking plates (LP) versus intramedullary interlocking (IMIL) nailing for treating these fractures.Materials and Methods: This was a prospective interventional study on 30 patients with extra-articular fractures of the lower third of tibia admitted under the Department of Orthopaedics between May 2021, and May 2022. Patients were allocated randomly into two groups with 15 patients each using coin toss to decide their mode of treatment. Patients got operated on with the respective mode of treatment and were followed up at 6 weeks, 3 months, and 6 months.Results: The most common mode of injury was found to be a Road Traffic Accident (RTA), seen in more than 50 percent of cases. The radiological union time we calculated was found to be 12.93 weeks for plating and 13.53 weeks for nailing. Four patients who underwent nailing developed malalignment compared to no patients in the plating group. The time taken after surgery to begin full weight bearing was 12.6±3 weeks for the intramedullary interlocking nailing group and 14.3±2.4 weeks for the plating group. Both groups had similar AOFAS scores with 11 in the intramedullary interlocking nailing group and 10 in the plating group obtaining excellent outcomes at the end of 6-month follow-up. Conclusion: IMIL nailing is superior to plating in terms of lower infection rates and time taken for full weight bearing and mobilization. However, plating is superior to IMIL nailing in terms of achieving a better anatomical, fixed reduction of the fracture.