Radiological outcomes of surgical treatment of closed distal tibia fractures
- MOJ Orthopedics & Rheumatology
-
MA Kolotsi, MV Ngcelwane, ME Mabitsela, MB Mthelebofu
Abstract
1.1. Introduction: Closed distal third tibia fractures are common
injuries in South Africa, where there is a high incidence of pedestrian and
motor vehicle accidents. The surgical options of treating these fractures
include intramedullary nail (IMN), open reduction and locking plate fixation, tibial
cannulated screw fixation with fibular plating, and external fixation. We
undertook the study to review the radiologic outcomes of closed extraarticular
fractures treated surgically with intramedullary nailing or anatomical locking
plate.
1.2. Methods: This was a retrospective cohort study of patients
with distal tibial extraarticular fractures treated surgically with
intramedullary nail or anatomical locking plate fixation. Data was collected
from hospital records over a 24-month period. The radiological evaluation and
measurements were made on Picture Archiving and Communication System (PACS).
1.3. Results: A total of 100 patients were included in the study.
Most of the patients were males 61 (61%) patients were male. The age range of patients
was 18 years to 77 years (median 38yrs). Eighty patients (80%) were treated
with intramedullary nailing and those treated with plating were 20 (20%). The
immediate post-operative anteroposterior (AP) view showed that 73 participants
had an acceptable alignment, and 27 patients had malalignment. Lateral view
showed that 98 participants had acceptable alignment (98%), with malalignment
in only two patients (2%). The RUST score showed 96% (n=96) of the patients had
union, and 4% (n=4) had non-union. At the final follow up at 9 months, one
patient that initially had good alignment ended up with malunion. Four patients
had non-union - one was amputated and three had revisions. Of the four patients
that had non-union, three were fixed with anterolateral plate and one treated
with IMN. In the 28 patients that had malunion, 26 were treated with
intramedullary nailing and two with anterolateral plate. IMN had 32.5% (26/80)
malunion rate, plating had 10% (2/20) malunion rate. The methods of fixation were
statistically significant (p-value 0.045) in malunion outcomes, with IMN having a higher malunion rate. Plating
resulted in a significantly higher rate of nonunion of 15% compared to 1.3% after
IMN (p-value 0.005.)
1.4.Conclusion: Intramedullary nail
treatment results in significantly higher malunion rate as compared to locking
plate fixation. Plate fixation leads to significantly higher non-union rate
compared to intramedullary nail fixation. These methods of fixations were
statistically significant in outcomes of malunion and nonunion. More careful consideration is recommended
intra-operatively when intramedullary nailing is done, to avoid malalignment.
Plating should be recommended only when IMN is contraindicated because of the
risk of non-union.
Keywords
osteosynthesis, dissection