J Korean Fract Soc.  2010 Apr;23(2):172-179. 10.12671/jkfs.2010.23.2.172.

The Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Proximal and Distal Tibia Fracture

• Kang JS
• Park SR
• Kim SR
• Park YG
• Jung JH
• Choi SW

• KMID: 1461540
• DOI: http://doi.org/10.12671/jkfs.2010.23.2.172

Abstract

PURPOSE
To compare the efficacy of the surgical treatment through the comparison of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary (IM) nailing in the treatment of the tibial shaft fractures expended to metaphysis retrospectively.
MATERIALS AND METHODS
Patients with proximal or distal third fracture of tibial shaft from May 2003 to Aug. 2006 were divided into two groups depending on the surgical method. Group A consisted of 30 patients treated with IM nailing, Group B was 29 patients treated with MIPO. The clinical outcomes were evaluated retrospectively from the time for bone union and callus formation confirmed by X-ray, functional score of knee or ankle joint, and complications including nonunion, malalignment and infection.
RESULTS
Bone union was seen radiologically at a mean of 17.4 weeks in group A, and 17.0 weeks in group B. In postoperative complications, group A showed two nonunion, two delayed-union, six malalignment, and two wound infection while group B showed only one delayed-union and one wound infection.
CONCLUSION
There were no significant differences in the time for bony union and functional score between IM nailing and MIPO. Conventional IM nailing with only interlocking technique showed higher incidence of malalignment and deformity than MIPO for the treatment of the proximal or distal third fracture of the tibial shaft.

Keyword

Tibial shaft fracture; Minimally invasive plate osteosynthesis; Intramedullary nailing

MeSH Terms

Ankle Joint
Bony Callus
Congenital Abnormalities
Fracture Fixation, Intramedullary
Humans
Incidence
Knee
Nails
Postoperative Complications
Retrospective Studies
Tibia
Wound Infection

Figure

• 

  Fig. 1 (A) A 33 year-old man with a proximal tibial fracture was treated with intramedullary nailing. Postoperative AP and lateral radiographs at 6 months showed a nonunion of the fracture and valgus malalignment. The nonunion site was plated using traditional technique which involves dynamic compression plate and autogenous bone grafting. (B) A 69 year-old man with a proximal tibial fracture was treated with intramedullary nailing. Postoperative AP and lateral radiographs at 12 months showed a nonunion of the fracture and valgus malalignment. The proximal tibial nonunion was treated with more thick intramedullary nailing and lateral unicortical plate in the state of limited open reduction.

• 

  Fig. 2 (A) Preoperative AP and lateral radiographs of the left ankle of a 50 year-old woman showed a distal tibial fracture (AO type 42, B2.2) with an associated fibular fracture. Postoperative AP and lateral radiographs at 22 weeks showed evidence of healing. The fibula was plated using traditional plating techniques in advance of an indirect reduction of the distal tibial fracture. The distal tibia was plated using minimally invasive technique. (B) Preoperative AP and lateral radiographs of the right tibia of a 51 year-old woman showed a proximal tibial fracture after a traffic accident. Postoperative AP and lateral radiographs at 40 weeks showed a union of the fracture with good alignment after percutaneous plating with MIPO technique.

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