Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures.
OBJECTIVE
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.
Department of Orthopaedic Surgery, West China Hospital of Sichuan University, No.37, Guo-xue-xiang, Chengdu, 610041, People's Republic of China.
Yong
Y
Li
Lei
L
Liu
Xin
X
Tang
Fuxing
F
Pei
Guanglin
G
Wang
Yue
Y
Fang
Hui
H
Zhang
Nicolas
N
Crook
D000328:Adult; D017760:Bone Malalignment / Q000209:etiology; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005596:Fractures, Closed / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D005597:Fractures, Open / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult