Union Time in Minimal Invasive Plate Osteosynthesis Versus Closed Intramedullary Nailing in Closed Distal Tibial Fracture: A Retrospective Study

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Arun Woranuch, MD
Porntipa Tantibundit, MD


Background: Distal tibial metaphyseal fracture is the second most common fracture of tibia. Treatment of this fracture is challenging due to the large medullary cavity, covering with subcutaneous, less muscular layer and vascular supply. Closed interlocking intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) are two surgical methods widely used to fix this fracture. However, a better union outcome had not been identified.

Objectives: To compare the rate of union within 12 weeks of IMN group versus MIPO group.

Materials and Methods: This is a retrospective cohort study, enrolled the patients with closed distal tibial fracture who were admitted to Orthopaedic ward, Khon Kaen Hospital, from 1 January 2017 to 30 June 2020. The primary outcome was rate of union within 12 weeks.

Results: Of 116 enrolled patients, 63 patients were in MIPO group and 53 were in IMN group. Mean ± SD age was 36.9±16.7 years; 87 were men (75%). The union rate within 12 weeks was 38 of 63 patients (60.3%) in MIPO group and 23 of 53 patients (43.3%) in IMN group, the union rate within 12 weeks was not statistically different in two groups (AOR 1.81; 95%CI 0.78-4.20 p=0.17). The secondary outcomes were not significantly different, except the total operation time (minutes) in MIPO group was significantly higher than IMN group (94.5±18.2 vs 75.3±19.8 p=0.01).

Conclusions: The use of MIPO technique versus IMN technique for treating closed distal tibial fracture was not significantly different in the rate of union within 12 weeks.


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