A prospective randomized comparative study of interlocking intramedullary nailing and plate fixation in the surgical management of distal third tibial fractures

Background: Extra-articular distal third tibial fractures remain challenging due to the region's anatomical characteristics and limited blood supply, with persistent controversy regarding the optimal fixation method between intramedullary nailing (IMN) and plate fixation. Methods: This prospective randomized comparative study enrolled 60 patients (30 per group) with extra-articular distal third tibial fractures at SMS Medical College, Jaipur, from January to December 2024. Group A underwent plate fixation (ORIF/MIPO), while Group B received intramedullary interlocking nailing. Outcomes were assessed using the AOFAS ankle-hindfoot score, visual analogue scale (VAS) for pain, and radiological union at 6 weeks, 3 months, 6 months, and 9 months. Results: Both groups were comparable in demographics and fracture characteristics. Mean operative time was significantly shorter in the nailing group (72.6±4.57 vs 93.2±4.94 minutes, p<0.001). Partial and full weight bearing were achieved significantly earlier in the nailing group (p=0.008 and p=0.003, respectively). AOFAS scores at 9 months were comparable between groups (93.1±2.12 vs 92.2±2.13, p=0.120). Complete radiological union was achieved in all patients by 9 months, and complications were minor and comparable between groups. Conclusions: Both intramedullary nailing and plate fixation are effective for extra-articular distal third tibial fractures, with comparable functional outcomes. Intramedullary nailing, however, offers shorter operative time, earlier weight bearing, and fewer wound complications, making it preferable when early mobilization is desired.