Syed Muhammad Khalid Karim, Zaki Idrees, Mkazim Rahim Najjad.
Comparison of closed intramedullary nailing and percutaneous plating in distal tibia metaphyseal fracture.
Pak J Surg Jan ;31(4):248-51.

Introduction:Our aim is to compare outcome of closed intramedullary nailing with locking compression plate in distal tibia metaphyseal fracture through minimal plate osteosynthesis for time to union, hard ware irritation and AOFAS (American Orthopedic Foot and Ankle surgery score) for functional evaluation. Method: Retrospective review of prospective collected study. It was conducted between January 2013 to June 2014. Total 30 patients were included in study. Randomly 15 patients were treated with closed intramedullary nailing and 15 patients were treated with locking compression plate through minimally plate osteosynthesis. Th ey were observed for time to union, hard ware pain and AOFAS (American Orthopedic Foot and Ankle surgery score) for functional evaluation. Results: Mean union time was 3.2 months (2.5- 4.0) months in all patients, 3.0 months for intramedullary nail group and 3.4 months for plate fi xation group their was no signifi cant diff erence between the groups (p=0.856).Ankle arthritis was evaluated by AOFAS scoring system. Th e mean AOFAS score was 86.8 (range 55-100). It was 87.8 (range 75-98) in intramedullary nailing group and 82.8 (range 71-97) in MIPO group. Th ere was no signifi cant diff erence between the groups according to AOFAS scoring system. (p= 0.754). Th irteen patients complaining for hard ware pain in plating group as compare to seven in tibia nail population. Conclusion:Percutaneous plating is usuallypreferred over nailing for treating 43-A type of fracture as distal fragment size is small. But in our observation intramedullary nailing is the bett er option as it has shorter time to union and good functional results as compare to MIPO LCP but technically, it is demanding.

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