Elastic Nailing With Kirschner Wires Versus Plate Fixation for Distal Tibial Fractures in Adolescents

Distal tibial metaphyseal‐diaphyseal junction fractures in adolescents can be difficultto treat because of the short distal fragment, proximity to the growth plate, andtendency toward displacement and malalignment. Elastic stable intramedullary nailing isminimally invasive and preserves the fracture biology, but fixation of the short distalfragment may be less stable. Supplementary Kirschner wires may improve rotational andangular stability. Plate fixation provides stable fixation and good control of alignmentbut may require greater soft‐tissue dissection.This study will be conducted at the Department of Orthopaedics Surgery, Sohag UniversityHospital. Eligible adolescents with displaced or unstable distal tibialmetaphyseal‐diaphyseal junction fractures requiring surgical fixation will be randomlyassigned to one of two treatment groups. Group A will undergo elastic stableintramedullary nailing supplemented by one or two Kirschner wires. Group B will undergoplate fixation using a distal tibial locking compression plate. Randomization will beperformed using a computer‐generated sequence in a 1:1 ratio.Patients will undergo clinical and radiological follow‐up at 2 weeks, 6 weeks, 3 months,and 6 months. The primary outcomes are time to radiological union and fracture unionrate. Secondary outcomes include coronal and sagittal alignment, time to fullweight‐bearing, AOFAS Ankle‐Hindfoot Score, Lower Extremity Functional Scale, andcomplications including malunion, delayed union, nonunion, infection, implant irritationor failure, and reoperation.