title: Distal tibial fractures: evaluation of different fixation techniques.
abstract: OBJECTIVE
  The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1).
  
  
  METHODS
  A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed.
  
  
  RESULTS
  A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively.
  
  
  CONCLUSIONS
  Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Julian
authors.initials: J
authors.lastname: Jöstl
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Thomas Manfred
authors.initials: TM
authors.lastname: Tiefenböck
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hofbauer
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Winnisch
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Lang
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hajdu
authors.affiliation: Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. kambiz.sarahrudi@meduniwien.ac.at.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Sarahrudi
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D001317:Austria / Q000453:epidemiology; D001860:Bone Plates / Q000706:statistics & numerical data*; D015331:Cohort Studies; D019544:Equipment Failure Analysis; D016267:External Fixators / Q000706:statistics & numerical data*; D005260:Female; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Bony consolidation; Distal tibial fractures; External fixation; IM nailing; Plate fixation; ROM