Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise

BACKGROUND: In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint.
METHODS: Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation.
RESULTS: No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient.
CONCLUSION: As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.

Mortise yakýn distal tibia diafiz kýrýklarýnýn tedavisinde intramedüller çivi ve plak tedavisinin karþýlaþtýrýlmasý

AMAÇ: Bu çalýþmada ayak bileði eklemine (mortis) yakýn distal tibia diafiz kýrýklarýnýn tedavisinde intramedüller çivi veya plak tedavisinin fonksiyonel ve radyolojik sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: 2005-2011 yýllarý arasýnda intramedüller çivi (21 hasta) veya plak (34 hasta) ile tedavi edilen 55 hasta (32 erkek, 23 kadýn; ortalama yaþ 42; daðýlým 15-72 yýl) çalýþmaya alýndý. Ortalama takip süresi 27.6 ay (daðýlým 12-82 ay) idi. Hastalar kaynamama (nonunion), yanlýþ kaynama (malunion), enfeksiyon, implant irrtasyonu ve klinik açýdan AOFAS (American Orthopaedic Foot and Ankle Society) skoru ile deðerlendirildi.
BULGULAR: Kýrýðýn ekleme uzaklýðý, kaynama zamaný, AOFAS skoru, ilave fibula kýrýðý, malunion, materyal irritasyonu açýsýndan istatistiksel fark gözlenmedi. Hastalarýn dokuz tanesinde açýk kýrýk mevcuttu ve bu hastalar plak ile tedavi edilmiþti (p=0.100). Plak ile tedavi edilen üç hastada kaynamama geliþti. Bir hastada enfeksiyon geliþti. Diz önü aðrýsý çivi yapýlan hastalarda istatistiksel olarak fazla idi. <10° malunion geliþen hastamýz yoktu. Çivi veya plak uygulanan hastalar arasýnda minimal malunion (13 hasta) açýsýndan karþýlaþtýrýldýðýnda fark yoktu.
TARTIÞMA: Distal tibia diafiz kýrýklarýnýn tedavisinde distal parça kýsa olduðu için genellikle plak tercih edilmektedir. Çalýþmamýzda cerrahi kurallara dikkat edildiðinde çivi tedavisinin malunionu artýrmadýðý bununla birlikte kapalý cerrahi ve daha az yara yeri problemi nedeniyle avantajlarý olduðunu gördük.