Recherche clinique sur le pied et la cheville

Abstrait

A comparative study of functional outcome of distal tibia extra articular fractures managed with intramedullary nailing and plating

Neetin Prahlad Mahajan, Tushar Patil, Jayesh Anant Mhatre, Mayur Kamble, Pravin Sarkunde, Kevin Jain

Introduction: The mechanism of injury and the prognosis of dis-placed, extra-articular fractures of the distal tibia is different to that for Pilon fractures, though ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the many tertiary care centres, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both of these techniques provide reliable fixation, but both are associated with specific complications. There is little information regarding the functional recovery following either procedure.

Material and Methods: We performed a randomised interventional prospective study for 18 months from January 2020 to June 2021 to determine the functional outcome of 48 patients managed with either a locking-plate (n = 24) or an intramedullary nailing (n = 24). Both groups were monitored with Olerud and Monrad ankle score (OMAS), visual analog score for pain assessment, physiotherapy was started in both group depending on the assessment of fixation and initially toe touch weight bearing was started on visibility of radiological callus and then later progressed to full weight bearing, patients were followed for minimum 9 months and relevant statistical tests were applied.

Results: amongst the two groups we had an average time to union of 16.5 weeks in the interlocking group while plating group had an average time of 19.23 weeks which was significant, also the average time required for the weight bearing was 4.5 weeks in nailing group compared to the 8.6 weeks in the plating group which was also significantly lower, there was lower incidence of the complications in the nailing group compared to the plating group.

Conclusion: our study demonstrates that both methods can be used in management of distal tibia extra articular fractures. Closed reduction and internal fixation with intramedullary interlocking nail has advantage of reduced time to union, early mobilisation and lesser incidence of complications compared to open reduction and internal fixation with plating.