Comparative study between intramedullary nail and Locked plate used in closed fracture extraarticular distal Tibia

Background: Distal tibial fractures are one of the most frequently encountered long bone fractures. Various treatment strategies have been investigated to manage displaced fractures in this region. The three primary methods commonly used include external fixation, locking plates and intramedullary nailing. This study aims to evaluate and compare the effectiveness of intramedullary nails and locking plates in treating these fractures. Materials and Methods: We analyzed data from 50 patients with distal tibial fractures, with fracture distances ranging from 40 to 100 mm from the joint. The patients were categorized into two groups based on their treatment method: intramedullary nailing and locking plates. We assessed both groups by comparing key factors such as average surgical duration, time to bone union, infection rates, and the occurrence of malunion or non-union. Additionally, we measured the time required for patients to achieve full weight-bearing. Functional recovery was evaluated using the Olreud & Molander scale and the Radiographic Union Scale for Tibial Fractures (RUST) at 1-, 3-, 4-, and 6-months post-treatment. Results: None of the patients in either group experienced non-union, and all achieved outcomes that were classified as either excellent or good. Specifically, 36 patients (72%) reached excellent outcomes, while 14 patients (28%) achieved good outcomes. Discussion: Our findings suggest that intramedullary nailing offers advantages over locking plates by reducing infection rates and significantly accelerating the time required to achieve full weight-bearing. However, LP proved superior in maintaining anatomical alignment, ensuring stable fracture reduction, and reducing union-related complications. Both treatment approaches yielded similar results in terms of surgical duration, hospital stay, fracture healing time, and functional outcomes. Notably, patients treated with intramedullary nailing demonstrated significantly higher scores on the Olreud & Molander and RUST scales, indicating better functional recovery. Conclusion: This research suggests that intramedullary interlocking nailing is more effective in promoting successful union and functional outcomes compared to extramedullary plating for closed extra-articular distal tibia fractures. Future research should involve larger sample sizes with balanced representation across treatment groups to yield more significant p-values.