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In a recent study published in The Journal of the American Medical Association (JAMA), research from Oxford Trauma in conjunction with Warwick Clinical Trials Unit shows that intramedullary nail fixation provides better quality of life for patients in the 12 months following a fracture of the distal tibia and costs less than ‘locking’ plate fixation.

Nail fixation provides better early outcomes for patients

The shin bone (tibia) is the most commonly broken bone in the leg. Injuries in the lower part of the shin bone (distal tibia) nearly always require hospital admission and usually require surgery. Existing research suggested that modern ‘locking’ plate fixation and intramedullary nail fixation are the most common types of operation performed for this fracture. However, it was not clear which provides better outcomes for patients.

In this study, 321 adult patients having surgery for a fracture of the distal tibia were given either nail fixation or ‘locking’ plate fixation. Using the Disability Rating Index, patients reported their own outcomes at three, six and 12 months after their fracture. Further information was also collected on the patient’s quality of life, complications suffered and associated costs of the treatment.

The Disability Rating Index of both groups of patients improved in the months after their surgery, although patients were not back to normal even a year later. Patients who had nail fixation of their tibial fracture showed evidence of improvement at three months but there were no differences between the treatments after six months. There was also no difference in the number of complications suffered by each group, but further surgery was more common in the ‘locking’ plate group. The economic analysis showed nail fixation was cheaper than ‘locking’ plate fixation.

Commenting on the findings, Matthew Costa, Professor of Orthopaedic Trauma Surgery said: “The results of the trial will not only influence the type of surgery offered to patients but also help reduce costs to the NHS”.

Read the full report on The Journal of the American Medical Association: