Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing.
OBJECTIVE
To compare intramedullary nailing (IMN) with external fixation (EF) in the treatment of tibial shaft fractures located within 5 cm of the ankle.


METHODS
University teaching hospital.


METHODS
Retrospective comparative study.


METHODS
Sixty-seven patients with a mean age of 48 years (range, 16-78 years; 24 women, 43 men).


METHODS
Thirty-three fractures were treated with EF from 1998 to 2004 and 34 fractures were treated with reamed IMN from 2004 to 2007.


METHODS
Olerud-Molander ankle score, RAND-36 Item Health Survey, and the number of secondary interventions.


RESULTS
The healing time was 21 weeks in the IMN group and 23 weeks in the EF group (P = 0.53). One fracture in the IMN group and three in the EF group malunited (P = 0.62). Olerud-Molander ankle score was 75 in the IMN group and 74 in the EF group (P = 0.51). There was no difference in any of the RAND-36 subscores measuring physical functioning. More patients in the EF group had secondary intervention resulting from delayed healing (8 versus 1, P = 0.03). The patients in the EF group also needed more secondary interventions as a result of any complication (15 versus 2, P < 0.001). There was one deep infection in the IMN group.


CONCLUSIONS
Distal extra-articular or simple intra-articular fractures can be treated with modern IMNs or nonbridging EF. Although functional results are similar, EF carries a significant greater risk of secondary interventions; based on these data, IMN is recommended.
Department of Orthopaedic and Trauma Surgery, University Hospital of Oulu, Oulu, Finland. Jukka.Ristiniemi@ppshp.fi
Jukka
J
Ristiniemi
Patrik
P
Luukinen
Pasi
P
Ohtonen
D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult