A Randomised Trial Comparing the Outcome of Expert Tibia Nailing and Plating for Distal Tibial Fractures.

Background: Management of distal tibial fracture is challenging as it has precarious blood supply and its subcutaneous location. It is frequently complicated by contusion, infection, delayed union, and nonunion and may lead to revision surgeries. Distal tibial fracture needs a stable fixation with minimum damage to the soft tissues by the surgical dissection and implants. The optimal method of fixation remains debatable. Traditional methods like open reduction and rigid internal fixation have been associated with infections and devitalization of soft tissues and hence have poor results.

Aims and objectives: The aim of our study is to compare the functional and radiological outcome of the distal tibial fractures treated by expert tibia nailing (ETN) and tibial plating.

Methodology: This study was carried out in Rajendra Institute of Medical Sciences, Ranchi. This is a prospective study, period from November 2021 to October 2022. Patients were randomized using computer-generated random numbers. Patients fulfilling the inclusion criteria were included and underwent operative intervention. 30 patients underwent surgery with ETN and 30 patients with locking compression plate. All patients were examined preoperatively, postoperatively and in follow-up period. Data regarding different parameters including, timing of surgery after trauma, operating time, intraoperative blood loss, any postoperative complications, and radiological and functional outcomes were recorded and analyzed.

Results: In the ETN group, 21 (70.0%) patients had excellent range of motion (ROM) with the American Orthopedic Foot and Ankle Society (AOFAS) score ranging from 90 to 100, 4 (13.3%) patients had good ROM with AOFAS score ranging from 80 to 90, and 5 (16.7%) patients had fair ROM with AOFAS score ranging from 70 to 80. In plating, 20 (66.7%) patients had excellent ROM with AOFAS score ranging from 90 to 100, 2 (6.7%) patients had good ROM with AOFAS score ranging from 80 to 90, and 8 (26.7%) patients had fair ROM with AOFAS score ranging from 70 to 80. In the ETN group, the mean union time (mean ± standard deviation [SD]) of patients was 5.0333 ± 1.0981 months. In the plating group, the mean union time (mean ± SD) of patients was 5.5000 ± 1.6135 months. There is no significant difference in terms of fracture union, delayed union, malunion, nonunion, and deep infection in both groups; however, in the expert tibial nailing group, there is lesser operating time, blood loss, and lesser chances of superficial infection as compared to plating.

Conclusion: Both ETN and plating offer no significant advantage over each other in terms of fracture union, delayed union, malunion, nonunion, and deep infection; but superficial infection, blood loss, and operating time are significantly less ( P < 0.05) in patients treated with expert tibial nail. The choice of implant should be considered with taking due care of fracture pattern, associated soft tissue condition, and expertise of the surgeon itself.