Ozan BEYTEMÜR, Alican Barış, Cem ALBAY, Serdar YÜKSEL, Sever ÇAĞLAR, Ender ALAGÖZ

Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2)

Objective: The aim of this study was to compare midterm functional and radiographic results of minimalinvasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distaltibial fractures (AO-OTA type 43 C1-C2).Methods: Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years.Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plateosteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPOgroup.Results: Functional results and complications of IMN and MIPO methods were assessed in 73 patients.The average union time was 16.4± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group(p¼ 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 inthe MIPO group (p¼ 0.013). Four patients in the IMN group experienced valgus malunion, while it wasnot observed in any patients in the MIPO group (p¼ 0.042). Recurvatum malunion was detected in 10patients in the MIPO group and not seen in the IMN group (p¼ 0.001). Ankle dorsiflexion angle was25.8± 4.5in the IMN group and 33.3± 8.9in the MIPO group (p¼ 0.000).Conclusion: Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO.Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in theMIPO group. MIPO is theŞrst preference according to the literature; however, successful results havebeen obtained with IMN in this fracture pattern.Level of Evidence: Level III, Therapeutic Study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

___

Katsenis DL, Begkas D, Spiliopoulos G, Stamoulis D, Pogiatzis K. The results of closed intramedullary nailing for intra-articular distal tibial fractures. J Orthop Trauma. 2014;28:108e113.

Ristiniemi J, Luukinen P, Ohtonen P. Surgical treatment of extra-articular or simple intraarticular distal tibial fractures: externalŞxation versus intra medullary nailing. J Orthop Trauma. 2011;25:101e105.

Marcus MS, Yoon RS, Langford J, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury. 2013;44:1107e1111.

Yu J, Li L, Wang T, et al. Intramedullary nail versus plate treatments for distal tibial fractures: a meta-analysis. Int J Surg. 2015;16:60e68.

Iqbal HJ, Pidikiti P. Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence. Foot Ankle Surg. 2013;19:143e147.

Xue XH, Yan SG, Cai XZ, Shi MM, Lin T. Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and metaanalysis. Injury. 2014;45:667e676.

Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plateŞxation. J Am Acad Orthop Surg. 2012;20:675e683.

Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2013;38:1261e1267.

Kuhn S, GreenŞeld J, Arand C, et al. Treatment of distal intraarticular tibial fractures:A biomechanical evaluation of intramedullary nailing vs. angle-stable plate osteosynthesis. Injury. 2015;46:99e103.

Polat A, Kose O, Canbora K, Yanık S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial frac- tures: a prospective randomized clinical trial. J Orthop Sci. 2015;20:695e701.

Konrath G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intra- medullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma. 1997;11(3):200e205.

Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. ClassiŞcation and treatment by locked intramedullary nailing. J Bone Jt Surg Br. 1995;77: 781e787.

Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709e714.

Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intra- medullary nailing. J Orthop Trauma. 2008;22:307e311.

Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classiŞcation com- pendium- 2007: orthopaedic trauma association classiŞcation, database and outcomes committee. J Orthop Trauma. 2007;21(Suppl. 10):S1eS133.

Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Ortop Trauma Surg. 1984;103:190e194.

Viberg B, Kleven S, Hamborg-Petersen E, Skov O. Complications and functional outcome afterŞxation of distal tibia fractures with locking plate - a multicentre study. Injury. 2016 Jul;47(7):1514e1518. pii: S0020-1383(16) 30126e7.

Vidovi c D, Matej ci c A, Ivica M, Juri si c D, Elabjer E, Bakota B. Minimally-invasive plate osteosynthesis in distal tibial fractures: results and complications. Injury. 2015;46:96e99.

Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009;129:773e777.

Egol KA, Weisz R, Hiebert R, Tejwani NC, Koval KJ, Sanders RW. DoesŞbular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures? J Orthop Trauma. 2006;20:94e103.