Research Article
Minimally-Invasive Plate or Intramedullar Nail in the Management of Distal Extra-Articular Tibial Fracture, What Is Better?
Abstract
Objective: The aim of this study was to compare the clinical and functional outcomes of patients with distal tibia extraarticular fractures treated with Intramedullary nailing (IMN) or Minimally invasive plate osteosynthesis (MIPO).
Materials and Methods: This retrospective study included 47 patients treated with IMN and 41 patients with MIPO. Clinical and radiographic results were evaluated at last follow-up. Anterior knee pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score and Lysholm knee scoring scale were used as clinical measurement.
Results: Although the union time and operation time were significantly higher in the IMN group compared to the MIPO group (p<0.001), the full weight bearing time and the hospital time were higher in the MIPO group (p<0.001). There were no statistical differences between wound problem, malposition, infection and grafting rates in both groups (p>0.05). Although the AOFAS score was statistically higher in the IMN group (p=0.031), the Lysholm knee score was higher in the MIPO group (p<0.001).
Conclusion: While MIPO is advantageous with low union time, low operating time and no damage to the knee joint, IMN allows earlier full weight bearing, lower hospitalization and has better ankle functional results.
Keywords:
References
- Casstevens C, Toan L, Archdeacon M, et al. Management of extra-articular fractures of the distal Tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20:675–683.
- Song X, Huang X, Yakufu M, Yan B, Feng C. Minimally invasive plate osteosynthesis or conventional intramedullary nailing for distal tibial fractures: A cohort study protocol. Medicine (Baltimore). 2020;99(33):e21779. doi:10.1097/MD.0000000000021779
- Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg. 2015;41:25–38.
- He X, Hu C, Zhou K, Zhai Q, Wen W, Pan F. Clinical and radiological outcome of Gustilo type III open distal tibial and tibial shaft fractures after staged treatment with posterolateral minimally invasive plate osteosynthesis (MIPO) technique. Arch Orthop Trauma Surg. 2018;138:1097–1102.
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative management of distal tibial extra-articular fractures - intramedullary nail versus minimally invasive percutaneous plate osteosynthesis. Ortop Traumatol Rehabil. 2017;19:537–541.
- Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, data-base and outcomes committee. J Orthop Trauma. 2007;21(10): S1-133. doi:10.1097/00005131-200711101-00001
- Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24:24–29.
- Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982. doi:10.1177/036354658201000306
- Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-988.
- Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38(6):1261-1267.
- Polat A, Kose O, Canbora K, Yanık S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial, J. Orthop. Sci. 2015;20(4):695–701.
- Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697-703. doi:10.1007/s00264-007-0384-z
- Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures, J. Orthop. Trauma. 2007;21(6):355–361.
- Shen J, Xu J, Tang MJ, Luo CF, Zhang CQ. Extra-articular distal tibia facture (AO-43A): A retrospective study comparing modified MIPPO with IMN. Injury. 2016;47(10):2352-2359. doi:10.1016/j.injury.2016.07.023
- Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:542–548.
- Goh EL, Chidambaram S, Eigenmann D, Ma S, Jones GG. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes. SICOT J. 2018;4:58. doi:10.1051/sicotj/2018055
- Lefaivre KA, Guy P, Chan H. Blachut PA. Long term follow up of tibial shaft fractures treated with intramedullary nailing. J orthop Trauma. 2008;22(8):525-9. doi:10.1097/BOT.0b013e318180e646
- Mauffrey C, McGuinness K, Parsons N, et al. A randomized pilot trial of “Locked Plate” fixations versus intramedullary nail for extraarticular fractures of the distal tibia. J Bone Joint Surg Br. 2012;94:704–708.
- Barcak E, Collinge CA. Metaphyseal Distal Tibia Fractures: A Cohort, Single-Surgeon Study Comparing Outcomes of Patients Treated With Minimally Invasive Plating Versus Intramedullary Nailing. J Orthop Trauma. 2016;30:169–174.
- Costa ML, Achten J, Griffin J, et al. Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia: the UKFixDT randomized clinical trial. Jama. 2017;318:1767–1776.
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative management of distal tibial extra-articular fractures intramedullary nail versus minimally invasive percutaneous plate osteosynthesis. Ortop Traumatol Rehabil. 2017;19:537–541.
- Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, Li Z, Zhang K, Hao D, Ma T, Lu Y. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):456. doi:10.1186/s13018-019-1479-0
- Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg. 2019;11(6):954-965. doi:10.1111/os.12575
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative Management of Distal Tibial Extra-articular Fractures - Intramedullary Nail Versus Minimally Invasive Percutaneous Plate Osteosynthesis. Ortop Traumatol Rehabil. 2017;19(6):537-541.
- Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthop Surg Res. 2015;10:95. doi:10.1186/s13018-015-0217-5
- Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury. 2006;37(6):531-5. doi:10.1016/j.injury.2005.09.013
- Janssen KW, Biert J, Van Kampen A. Treatment of distal tibial fractures: Plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31(5):709-14. doi:10.1007/s00264-006-0237-1
- Giovanni N, Camillo F, Maurizo M, et al. Intramedullary nailing through a suprapatellar approach. Evaluation of clinical outcome after removal of the device using the infrapatellar approach. Acta Bio Medica: Atenei Parmensis. 2019;90(1):130-135.
- Çiçekli Ö, Kochai A, Şükür E, Başak AM, Kurtoğlu A, Türker M. Suprapatellar approach for fractures of the tibia: Does the fracture level matter? Eklem Hastalik Cerrahisi. 2019;30(1):10-16.
- Lu Y ,Wang G, Hu B, et al. Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures. J Orthop Surg Res. 2020;15(1):422. doi:10.1186/s13018-020-01960-8
Distal Ekstra-Artiküler Tibia Kırığının Tedavisinde Minimal İnvaziv Plak veya İntramedüller Çivi, Hangisi Daha İyi?
Abstract
Amaç: Bu çalışmanın amacı, intramedüller çivileme (IMN) veya minimal invaziv plak osteosentezi (MIPO) ile tedavi edilen distal tibia ekstraartiküler kırıklı hastaların klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.
Materyal ve Metot: Bu retrospektif çalışma, IMN ile tedavi edilen 47 hastayı ve MIPO ile tedavi edilen 41 hastayı içermektedir. Klinik ve radyografik sonuçlar son takipte değerlendirildi. Klinik ölçüm olarak ön diz ağrısı, Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) Ayak Bileği-Arka Ayak Ölçeği puanı ve Lysholm diz puanlama ölçeği kullanıldı.
Bulgular: İki gruptaki hiçbir hastada kaynamama geliştirmedi. IMN grubunda kaynama süresi ve operasyon süresi MIPO grubuna göre anlamlı olarak daha yüksek olmasına rağmen (p<0,001), MIPO grubunda tam yük taşıma süresi ve hastanede kalma süresi daha yüksekti (p<0,001). Gruplar arasında yara sorunu, yanlış pozisyon, enfeksiyon ve greftleme oranları açısından istatistiksel olarak fark yoktu (p>0,05). AOFAS skoru IMN grubunda istatistiksel olarak daha yüksek olmasına rağmen (p=0,031), Lysholm diz skoru MIPO grubunda daha yüksekti (p<0,001).
Sonuç: MIPO, erken kaynama, kısa operasyon süresi ve diz eklemine zarar vermemesi ile avantajlıyken, IMN daha erken tam yük taşımaya, daha kısa hastanede yatmaya ve daha iyi ayak bileği fonksiyonel sonuçları elde etmeyi sağlamaktadır.
References
- Casstevens C, Toan L, Archdeacon M, et al. Management of extra-articular fractures of the distal Tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20:675–683.
- Song X, Huang X, Yakufu M, Yan B, Feng C. Minimally invasive plate osteosynthesis or conventional intramedullary nailing for distal tibial fractures: A cohort study protocol. Medicine (Baltimore). 2020;99(33):e21779. doi:10.1097/MD.0000000000021779
- Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg. 2015;41:25–38.
- He X, Hu C, Zhou K, Zhai Q, Wen W, Pan F. Clinical and radiological outcome of Gustilo type III open distal tibial and tibial shaft fractures after staged treatment with posterolateral minimally invasive plate osteosynthesis (MIPO) technique. Arch Orthop Trauma Surg. 2018;138:1097–1102.
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative management of distal tibial extra-articular fractures - intramedullary nail versus minimally invasive percutaneous plate osteosynthesis. Ortop Traumatol Rehabil. 2017;19:537–541.
- Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, data-base and outcomes committee. J Orthop Trauma. 2007;21(10): S1-133. doi:10.1097/00005131-200711101-00001
- Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24:24–29.
- Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982. doi:10.1177/036354658201000306
- Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-988.
- Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014;38(6):1261-1267.
- Polat A, Kose O, Canbora K, Yanık S, Guler F. Intramedullary nailing versus minimally invasive plate osteosynthesis for distal extra-articular tibial fractures: a prospective randomized clinical trial, J. Orthop. Sci. 2015;20(4):695–701.
- Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008;32(5):697-703. doi:10.1007/s00264-007-0384-z
- Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures, J. Orthop. Trauma. 2007;21(6):355–361.
- Shen J, Xu J, Tang MJ, Luo CF, Zhang CQ. Extra-articular distal tibia facture (AO-43A): A retrospective study comparing modified MIPPO with IMN. Injury. 2016;47(10):2352-2359. doi:10.1016/j.injury.2016.07.023
- Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:542–548.
- Goh EL, Chidambaram S, Eigenmann D, Ma S, Jones GG. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes. SICOT J. 2018;4:58. doi:10.1051/sicotj/2018055
- Lefaivre KA, Guy P, Chan H. Blachut PA. Long term follow up of tibial shaft fractures treated with intramedullary nailing. J orthop Trauma. 2008;22(8):525-9. doi:10.1097/BOT.0b013e318180e646
- Mauffrey C, McGuinness K, Parsons N, et al. A randomized pilot trial of “Locked Plate” fixations versus intramedullary nail for extraarticular fractures of the distal tibia. J Bone Joint Surg Br. 2012;94:704–708.
- Barcak E, Collinge CA. Metaphyseal Distal Tibia Fractures: A Cohort, Single-Surgeon Study Comparing Outcomes of Patients Treated With Minimally Invasive Plating Versus Intramedullary Nailing. J Orthop Trauma. 2016;30:169–174.
- Costa ML, Achten J, Griffin J, et al. Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia: the UKFixDT randomized clinical trial. Jama. 2017;318:1767–1776.
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative management of distal tibial extra-articular fractures intramedullary nail versus minimally invasive percutaneous plate osteosynthesis. Ortop Traumatol Rehabil. 2017;19:537–541.
- Wang B, Zhao Y, Wang Q, Hu B, Sun L, Ren C, Li Z, Zhang K, Hao D, Ma T, Lu Y. Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14(1):456. doi:10.1186/s13018-019-1479-0
- Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg. 2019;11(6):954-965. doi:10.1111/os.12575
- Wani IH, Ul Gani N, Yaseen M, Bashir A, Bhat MS, Farooq M. Operative Management of Distal Tibial Extra-articular Fractures - Intramedullary Nail Versus Minimally Invasive Percutaneous Plate Osteosynthesis. Ortop Traumatol Rehabil. 2017;19(6):537-541.
- Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P. Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis. J Orthop Surg Res. 2015;10:95. doi:10.1186/s13018-015-0217-5
- Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury. 2006;37(6):531-5. doi:10.1016/j.injury.2005.09.013
- Janssen KW, Biert J, Van Kampen A. Treatment of distal tibial fractures: Plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31(5):709-14. doi:10.1007/s00264-006-0237-1
- Giovanni N, Camillo F, Maurizo M, et al. Intramedullary nailing through a suprapatellar approach. Evaluation of clinical outcome after removal of the device using the infrapatellar approach. Acta Bio Medica: Atenei Parmensis. 2019;90(1):130-135.
- Çiçekli Ö, Kochai A, Şükür E, Başak AM, Kurtoğlu A, Türker M. Suprapatellar approach for fractures of the tibia: Does the fracture level matter? Eklem Hastalik Cerrahisi. 2019;30(1):10-16.
- Lu Y ,Wang G, Hu B, et al. Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures. J Orthop Surg Res. 2020;15(1):422. doi:10.1186/s13018-020-01960-8
There are 30 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research article |
| Authors | |
| Publication Date | March 1, 2022 |
| Submission Date | January 12, 2022 |
| Acceptance Date | January 22, 2022 |
| Published in Issue | Year 2022 Volume: 7 Issue: 1 |
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