Interlocking intramedullary nailing versus percutaneous plating in osteosynthesis of metaphyseal fractures of distal tibia.

Objective To compare the clinic effects of interlocking intramedullary nailing and percutaneous plating in osteosynthesis of the metaphyseal fractures of distal tibia. Methods Between May 2004 and August 2005, 51 cases of metaphyseal fracture of distal tibia were treated in our department. With interlocking intramedullary nails were applied in 27 cases, and percutaneous plates in 24 cases. All the patients were followed up for averagely 21.2 month (from 12 to 27months). Their functional and radiographic outcomes were collected to compare the differences in operation time, intra-operative blood loss, X-ray exposure, bone union time, post-operative complications, posterior or anterior angulation of ankle joint, varus or valgus angulation of ankle joint, and the maximum ankle dorsiflexion degrees. Olerud-Molander functional ankle score system was used to evaluate the results. Results There was no significant difference in operation time, X-ray exposure and the maximum ankle dorsiflexion degrees between the two groups. Patients in both groups got bony union. The mean union time was 20.0 weeks for the nailing group and 18.6 weeks for the plating group. Most patients got satisfactory functional recovery of ankle joint by Olerud-Molander system. The interlocking intramedullary nailing group suffered less intra-operational blood loss, while the percutaneous plating group had better bone fracture alignment. Five cases in the nailing group got malunion, and 4 cases in the plating group had local soft tissue infections. Conclusions Both interlocking intramedullary nailing and percutaneous plating are proper osteosynthesis for the metaphyseal fractures of distal tibia. Comparatively, percutaneous plate osteosynthesis can provide better fragmental stability, but it is safer to treat fractures combined with local soft tissue injury with interlocking nailing.