title: Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases.
abstract: OBJECTIVE
  To compare extra-articular proximal tibial fractures treated with intramedullary nailing (IMN) or percutaneous locked plating (PLP) and assess the ability of each technique to obtain and maintain fracture reduction.
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  : Level 1 Trauma Center.
  
  
  METHODS
  Beginning with the first use of PLP of the proximal tibia at our institution, all skeletally mature patients with surgically treated proximal extra-articular tibial fractures were reviewed. Between August 1999 and June 2004, 29 patients treated with intramedullary nails and 43 patients treated with percutaneous locked plates were identified. Patients with at least 1-year follow-up included 22 IMN and 34 PLP cases, which formed the final study group.
  
  
  METHODS
  Final outcomes were assessed for the IMN and the PLP groups by comparing rates of union, malunion, malreduction (defined as >5 degrees angulation in any plane), infection, and removal of implants.
  
  
  RESULTS
  The IMN and PLP groups showed similar age and gender demographics. Average length of follow-up was 3.4 years in the IMN group (15-67 months) and 2.7 years in the PLP group (12-66 months). Open fractures made up 55% of the IMN group and 35% of the PLP group. Final union rates (after additional procedures for nonunions after the index procedure) were similar between groups (IMN = 96% and PLP = 97%). Implant removal in the PLP group was 3 times greater than in the IMN group, (P = 0.390), whereas an apex anterior (procurvatum) malreduction deformity occurred twice as frequently in the IMN group (P = 0.103). Additional surgical techniques (eg, blocking screws) were frequently used during reduction within the IMN group and infrequently used within the PLP group (P = 0.0002). Neither technique resulted in a statistically significant loss of final reduction confirming the stability of each construct.
  
  
  CONCLUSIONS
  Neither IMN or PLP showed a distinct advantage in the treatment of proximal extra-articular tibial fractures. Apex anterior malreduction however was the most prevalent form of malreduction in both groups. Additional surgical reduction techniques were frequently needed with IMN, whereas removal of implants seems to be more commonly needed with PLP.
authors.affiliation: Department of Orthopaedics, Community Regional Medical Center, UCSF-Fresno, 7th Floor W, 2823 Fresno St, Fresno, CA 93721, USA. elindvall@fresno.ucsf.edu
authors.forename: Eric
authors.initials: E
authors.lastname: Lindvall
authors.forename: Roy
authors.initials: R
authors.lastname: Sanders
authors.forename: Thomas
authors.initials: T
authors.lastname: Dipasquale
authors.forename: Dolfi
authors.initials: D
authors.lastname: Herscovici
authors.forename: George
authors.initials: G
authors.lastname: Haidukewych
authors.forename: Claude
authors.initials: C
authors.lastname: Sagi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult