A Randomized Trial Comparing Outcome of Expert Tibial Nail versus Proximal Tibial Plate in the Management of Fractures of Proximal Tibia in Adults.

Abstract

Background: Extra-articular fracture of the proximal tibia frequently results in functional impairment of the knee and lower limb if not managed properly. Any treatment method must achieve the desired anatomical reduction and stable fixation to permit early weight-bearing and joint motion. This type of fracture can be treated using a variety of methods, from conservative casting to surgical management. It is still for debate that, which surgical procedure is best for treating extra-articular proximal tibia fractures.

Aim: This study aims to compare the functional and radiological outcome of expert tibia nailing and proximal tibia plating in extra-articular proximal tibia fractures.

Methodology: This study was carried out in Rajendra Institute of Medical Sciences, Ranchi. This is a prospective study, from November 2021 to October 2022. Forty patients were selected in our study after fulfilling the inclusion criteria. Patients were randomized into two equal groups using computer-generated random numbers. Of 40 patients, 20 patients underwent surgical intervention using expert tibial interlocking nail and 20 with using plate and screws after approval from the Institutional Ethics Committee. All patients were examined preoperatively, postoperatively, and in follow-up period. The data regarding different parameters including the timing of surgery after trauma, operating time, intraoperative blood loss, duration of hospital stay, any postoperative complications, radiological, and functional outcomes were recorded and analyzed.

Results: Both the groups had excellent outcomes, and no statistically significant difference was found between both the groups in terms of functional outcome using the Oxford Knee Score. However, there was statistically significant difference present in mean union time (in weeks) with lesser duration in the Expert ILN group using the Radiographic Union Scale for Tibia score (P < 0.001).

Conclusions: Both plating and expert tibial nailing offer no significant advantages over each other in terms of functional outcome in the management of proximal tibia fracture. However, Expert ILN is associated with lesser union time but with higher risks of malunion, and plating is associated with more intra-operative blood loss, higher rate of postoperative infection, and a longer length of hospital stay.