Evaluating Fixation Strategies in Distal Tibial Fractures: Nailing versus Plating

Abstract Introduction: Distal tibial fractures account for approximately 7% of all tibial fractures and can present a management challenge because of their inherent instability, scarcity of soft tissues, subcutaneous nature, and poor vascularity of bone. Despite the availability of various modern techniques, there is either no or insufficient evidence to draw definitive conclusions on the best surgical intervention. The study compares functional and radiological outcomes for intramedullary nailing (IMN) with distal tibia-locking compression plates for treating extra-articular distal tibial fractures. Methodology: Ninety patients with extra-articular distal tibia fractures were included, meeting specific inclusion and exclusion criteria. These patients, treated at a tertiary care hospital, were randomly assigned to either IMN or distal tibia-locking compression plate fixation. Data on demographics, surgery details, and complications were recorded. Functional outcomes were assessed at 3, 6, and 12 months using the Olreud–Molander Ankle Score (OMAS) and the Radiographic Union Scale for Tibial fractures. Results: Group B had shorter surgery durations, a shorter hospital stay, and reached weight-bearing milestones earlier than Group A. Group B also demonstrated better functional and radiological outcomes, with higher OMAS scores and superior radiographic union scores at 3, 6, and 12 months postsurgery. However, both groups had similar rates of malunion and nonunion. Group A had a higher rate of superficial wound infections, while Group B reported more cases of knee pain. Conclusion: IMN provides better surgical and postoperative outcomes, quicker weight-bearing milestones, improved functional recovery, and enhanced radiographic healing compared to distal tibia-locking compression plates. Despite these advantages, each surgical method carries potential complications, highlighting the need for individualized patient assessment when selecting the appropriate treatment approach.