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2014 ; 38
(6
): 1261-7
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Treatment of distal tibial shaft fractures by three different surgical methods: a
randomized, prospective study
#MMPMID24549966
Li Y
; Jiang X
; Guo Q
; Zhu L
; Ye T
; Chen A
Int Orthop
2014[Jun]; 38
(6
): 1261-7
PMID24549966
show ga
PURPOSE: A few studies focused on the methods of treatment for displaced distal
tibial shaft fractures have been published, all of which compared two different
methods. In this randomized, prospective study, we aimed to compare minimally
invasive plate osteosynthesis, locking intramedullary nail stabilization and
external fixation combined with limited open reduction and absorbable internal
fixation for distal tibial shaft fractures by assessing complications and
secondary procedures. METHODS: From November 2002 to June 2012, 137 skeletally
mature patients with displaced distal tibial shaft fractures with or without
fibula fracture were randomized to be treated by minimally invasive plate
osteosynthesis (group A, n?=?46), locking intramedullary nail (group B, n?=?46)
or external fixation combined with limited open reduction and absorbable internal
fixation (group C, n?=?45). Age, gender, mechanism of injury, fracture pattern
and presence of open fracture were equally distributed among the three groups.
Indexes for evaluation included hospital stay, operative time, time to
radiographic union, union status, infection and the incidence of re-operation.
Mazur ankle score was introduced for functional evaluation. Statistics Analysis
System (SAS) 9.2 was used for analysis. RESULTS: A total of 121 patients were
included in the final analysis (group A 42, group B 40 and group C 39) and
evaluated after a mean of 14.8 months follow-up. There was no significant
difference (P?>?0.05) in hospital stay, time to radiographic union and the
incidence of union status among the three groups. Although group C was associated
with less secondary procedures versus groups A and B, it was related with more
pin tract infections (15.4 %). Anterior knee pain occurred frequently after
locking intramedullary nailing (37.5 %) and the irritation symptoms were more
frequently encountered in group A (59.5 %). There was no difference in ankle
function between the three methods after operation (P?>?0.05). CONCLUSIONS: We
consider that the minimally invasive plate osteosynthesis, locking intramedullary
nail stabilization and external fixation combined with limited open reduction and
absorbable internal fixation techniques are all efficient methods for treating
distal tibia fractures. With its wide indications, external fixation combined
with limited open reduction and absorbable internal fixation leads to minimal
soft tissue complication, good functional result and no local soft tissue
irritation or implant removal.