Comparison of surgical management of extra-articular distal tibia fractures treated with closed intramedullary nailing and minimally invasive percutaneous plate osteosynthesis- a prospective study

Background: We compared the clinical, radiological and functional outcome of extra-articular distal tibia fractures treated with Minimal invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) Methods: A prospective study included 51 patients (IMN-25 patients, MIPO-26 patients). Two groups were compared for mean operative time, mean hospital stay, mean healing time, complications, reoperations and mean American Orthopaedic Foot and Ankle surgery (AOFAS) score. Results: Significant difference was observed in mean duration of hospital stay (p-0.0001). There was no significant difference in mean healing time and mean operative time in between the two groups. Mean AOFAS score was 88.24 ± 5.19 in IMN and 86.96 ± 6.9 in MIPO group and the difference was not significant (p-0.78). Malalignment was higher in MIPO group (15.3%) as compared to IMN group (12%) but there was no statistically significant difference (p-0.36). One patient in MIPO group in which fibular osteotomy was done developed valgus deformity. Incidence of infection was higher in the MIPO group (11.5%) as compared to IMN group (4%) but the difference was not significant (p=0.15). Non-union, delayed union and resurgeries were almost similar between the two groups. Conclusion: Both IMN and MIPO can be safely used to treat distal tibia extra-articular fractures but IMN has the definite advantage of shorter mean hospital stay duration. Fibula fracture, if in distal third should be fixed as it aids in tibia reduction and imparts additional stability to the fixation. The role of fibular osteotomy in simple distal tibia fractures remains controversial and demands further studies.