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The ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the UK, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both techniques provide reliable fixation but both are associated with specific complications. There is little information regarding the functional recovery following either procedure. We performed a randomised pilot trial to determine the functional outcome of 24 adult patients treated with either a locking-plate (n = 12) or an intramedullary nailing (n = 12). At six months, there was an adjusted difference of 13 points in the Disability Rating Index in favour of the intramedullary nail. However, this was not statistically significant in this pilot trial (p = 0.498). A total of seven patients required further surgery in the locking-plate group and one in the intramedullary nail group. This study suggests that there may be clinically relevant, functional differences in patients treated with nail versus locking-plate fixation for fractures of the distal tibia and differences in related complications. Further trials are required to confirm the findings of this pilot investigation.

Original publication

DOI

10.1302/0301-620x.94b5.28498

Type

Journal article

Journal

The Journal of bone and joint surgery. British volume

Publication Date

05/2012

Volume

94

Pages

704 - 708

Addresses

Warwick Orthopaedics, University of Warwick, Warwick, United Kingdom. cyril.mauffrey@dhha.org

Keywords

Humans, Tibial Fractures, Disability Evaluation, Treatment Outcome, Fracture Fixation, Internal, Fracture Fixation, Intramedullary, Pilot Projects, Bone Nails, Bone Plates, Recovery of Function, Adult, Middle Aged, Female, Male, Young Adult