Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures.

PURPOSE: The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures. METHODS: Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed. RESULTS: The mean followed-up was 24.7±2.7 months in group A and 25.8±2.8 months in group B. No patient had nonunion, shortening, hardware breakdown, or deep-seated infection. Patients in group A had a significantly shorter mean operating time, hospital stay, full weight-bearing time and union time (76±16.6 vs. 90±20.3 minutes, p=0.000; 5.8±2.1 vs. 8.9±3.1 days, p=0.000; 9.0±1.4 vs. 11.1±1.7 weeks, p=0.000; and 21.3±3.5 vs. 23.1±3.6 weeks, p=0.047, respectively). Three patients in group A and one patient in group B presented with malalignment (p=0.608). The mean Olerud-Molander Ankle score was 89.0±7.1 in group A and 87.6±8.4 in group B (p=0.478). CONCLUSIONS: Distal tibia metadiaphyseal fractures may be treated successfully with low, multidirectional locked nails or plates. However, low, multidirectional locked nailing may represent a superior surgical option, since it offers advantages in terms of mean operating time, hospital stay, full weight-bearing time and union time.