Tag Archives: Union
Clinical and Radiological Outcomes of Open Reduction and Plate Fixation for Displaced Midshaft Clavicle Fractures: A Single-Centre Series
Vol 11 | Issue 2 | July-December 2025 | page: 10-13 | Akhil Chauhan, Chetan Pradhan, Atul Patil, Chetan Puram, Darshan Sonawane, Ashok Shyam, Parag Sancheti
https://doi.org/10.13107/jmt.2025.v11.i02.262
Author: Akhil Chauhan [1], Chetan Pradhan [1], Atul Patil [1], Chetan Puram [1], Darshan Sonawane [1], Ashok Shyam [1], Parag Sancheti [1]
[1] Sancheti Institute of Orthopaedics and Rehabilitation PG College, Shivajinagar, Pune, Maharashtra, India.
Address of Correspondence
Dr. Akhil Chauhan
Sancheti Institute of Orthopaedics and Rehabilitation PG College, Shivajinagar, Pune, Maharashtra, India.
E-mail: akhilchauhan94@gmail.com
Abstract
Background: Displaced midshaft clavicle fractures often heal poorly with conservative care and may result in malunion, nonunion or persistent shoulder dysfunction. This study reports outcomes after open reduction and plate fixation.
Methods: Thirty adults with displaced midshaft clavicle fractures treated between July 2019 and December 2021 underwent plate osteosynthesis via an anterosuperior approach. A standardized rehabilitation protocol was followed. Patients were reviewed at 6 weeks, 3, 6 and 12 months with radiographs, VAS pain scoring and validated functional measures (Constant, UCLA, and SF-36). Intraoperative details and complications were recorded.
Results: All patients united radiologically by final follow-up. Median age was 32 years. Functional scores improved steadily, with median Constant scores around 80–85 and UCLA scores in the mid-30s at one year. Median VAS pain scores fell to low values. No deep infections, implant failures or nonunion occurred. Two patients experienced symptomatic implant prominence managed without immediate surgery. Median operative time was approximately 50 minutes with minimal blood loss recorded.
Conclusion: Plate fixation reliably restored clavicular length and alignment in selected displaced midshaft fractures, produced predictable union and satisfactory shoulder function, and allowed early mobilization. Preoperative counselling about possible implant irritation remains essential.
Keywords: Clavicle fracture, Midshaft, Plate fixation, Union, Functional outcome
Introduction
Clavicle fractures are a frequent injury in orthopaedic practice, most commonly affecting the middle third of the bone. The clavicle’s curved shape and its superficial position beneath the skin make it particularly prone to displacement after direct shoulder impact or high-energy trauma. In many cases, minor fractures heal well without surgery, but when the midshaft fragment is significantly displaced, shortened or comminuted, conservative treatment has been shown to produce disappointing outcomes in a notable proportion of patients. These outcomes include symptomatic malunion, nonunion and persistent shoulder dysfunction, especially in active adults and those with high functional demands. [1–6]
Surgical fixation aims to restore the clavicle’s length, alignment and rotation so that shoulder mechanics are re-established and pain and disability resolve more predictably. The two main operative approaches are plate osteosynthesis and intramedullary fixation. Plating provides strong cortical purchase and excellent control of rotation and length, making it preferable in comminuted or segmental fractures; however, plates sit directly under thin soft tissue and can be prominent or bothersome. Intramedullary nails or elastic devices require smaller incisions and preserve more soft tissue, offering cosmetic and early comfort advantages in suitable patterns, but they may provide less rotational stability in complex fracture configurations and occasionally migrate. [7–12]
Recent comparative studies and reviews suggest that, for markedly displaced midshaft fractures, operative fixation reduces the risk of nonunion and often speeds functional recovery compared with nonoperative management, albeit at the expense of implant-related complaints in some patients. Given these trade-offs, modern practice tends to be selective: nonoperative care for minimally displaced, stable fractures, and operative fixation—commonly plate fixation—for displaced, shortened or comminuted midshaft injuries in active patients who want a reliable, timely return to function. This series reports outcomes after open reduction and plate fixation, focusing on union, functional recovery, pain and complications to inform shared decision making. [13–16]
Review of literature
Epidemiological studies show the midshaft as the most commonly fractured segment of the clavicle; mechanisms include direct blows to the shoulder and road-traffic or sports injuries. Early outcome reports noted low absolute nonunion rates after conservative care, but closer analysis revealed that completely displaced or significantly shortened midshaft fractures were at increased risk of symptomatic malunion and functional deficit. Those observations prompted randomized trials and cohort studies that compared nonoperative management with surgical fixation. [1–5]
Classification systems remain useful clinical tools. Simple schemes that group fractures by location are practical for routine care, while more detailed systems help identify fracture patterns less likely to do well without fixation. This aids prognostication and helps surgeons choose between conservative and operative approaches. [2,3]
Plating restores length and resists bending and torsional forces; it is especially valuable in comminuted or segmental fractures where maintaining reduction is otherwise difficult. Modern precontoured and locking plates aim to lower prominence and mechanical failure, but hardware irritation under thin soft tissue remains a real concern. Intramedullary fixation preserves periosteal blood supply and soft tissue, often using smaller incisions and producing early comfort in simple transverse fractures; however, nails give less rotational control in multifragmentary patterns and carry a small risk of migration. [7–12]
Systematic reviews and meta-analyses that pool randomized and observational trials indicate that surgery—especially plating—for displaced midshaft fractures reduces nonunion risk and can speed early functional recovery, though implant-related problems and subsequent operations for hardware removal are commonly reported. Taken together, the literature advocates a tailored approach: conservative care for stable, minimally displaced fractures and operative fixation for displaced, shortened or comminuted midshaft fractures in active patients willing to accept implant-related trade-offs. [13–19]
Materials and Methods
This single-centre series combined prospective and retrospective data from thirty adult patients treated with open reduction and plate fixation for displaced midshaft clavicle fractures between July 2019 and December 2021. Patients were included if they were over 18 years old and had displacement or shortening greater than 20 mm, marked comminution, segmental fracture patterns, floating shoulder or evident scapular malposition. Exclusions were presenting neurovascular injury, local infection, or inability to comply with postoperative follow-up.
All patients underwent clinical assessment and standard radiographs prior to surgery. Routine blood tests and anaesthesia fitness were confirmed. Procedures were performed under general anaesthesia with the patient in the beach-chair position. An anterosuperior transverse approach centred over the fracture was used in most cases. Careful soft-tissue dissection preserved the clavipectoral fascia and supraclavicular nerve branches when possible. Reduction was achieved with pointed bone clamps and provisional fixation (small fragment screws) where helpful. A contoured reconstruction or anatomically precontoured locking plate was applied to restore length and control rotation; cortical or locking screws were used as indicated and screw lengths checked under fluoroscopy to avoid joint penetration and minimise prominence.
Postoperative care included short sling immobilisation with early pendulum and passive range-of-motion exercises, followed by a graduated physiotherapy programme. Follow-up visits were at 6 weeks, 3 months, 6 months and 12 months with serial radiographs and assessments of shoulder range of motion, pain by visual analogue scale (VAS) and validated functional instruments (Constant and UCLA scores; SF-36 for general health). Intraoperative data (operative time, estimated blood loss) and any complications were prospectively recorded. Institutional ethics approval and informed consent were obtained for all patients.
Results
Thirty consecutive patients met the inclusion criteria and underwent open reduction with plate fixation. The cohort’s median age was 32 years (range 19–64); 22 were male and eight female. Road-traffic accidents were the predominant cause of injury. The median interval from injury to surgery was about 36 hours. Mean operative time averaged roughly 50 minutes and blood loss was minimal in most cases.
Radiographic callus formation was commonly visible between six and twelve weeks, and all patients achieved radiological union by final review. Functional recovery improved steadily: median Constant scores at one year were around 80–85 and UCLA scores clustered in the mid-30s. Pain scores fell sharply from preoperative levels, with median VAS near minimal values at 12 months. There were no deep infections, implant failures or nonunions recorded in this series. Two patients reported symptomatic implant prominence; both were managed conservatively without immediate return to the operating room. The majority returned to their previous daily activities and work and expressed satisfaction with the cosmetic and functional results.
Discussion
This series reinforces that plate fixation offers predictable restoration of clavicular length and alignment and leads to reliable union and satisfactory shoulder function in selected displaced midshaft fractures. The rigidity and rotational control conferred by plating are especially valuable in comminuted and segmental injuries, where maintaining accurate reduction is crucial for restoring shoulder mechanics and avoiding symptomatic malunion. [10–12] Intramedullary techniques remain useful for simple transverse fractures because they preserve soft tissues and often result in smaller wounds and early comfort, but their lesser rotational stability limits their role in complex patterns and raises concerns about potential migration. [8, 9]
Although operative fixation lowers nonunion risk and can accelerate early functional recovery for markedly displaced fractures, implant-related irritation and hardware prominence are the most frequent drawbacks. Low-profile and precontoured plates and careful intraoperative contouring reduce the incidence of symptomatic implants, but they do not eliminate it; patients should be counselled clearly about the possibility of later implant removal. [14–19]
The strengths of this work include consistent surgical technique, standardized follow-up and the use of validated outcome measures. Limitations include the single-centre setting, modest cohort size and mixed prospective/retrospective design, which may affect generalisability and introduce selection bias. Despite these limitations, the findings align with larger series and meta-analyses that support a selective surgical strategy—typically plating—for displaced midshaft clavicle fractures in active adults who prioritise a reliable, timely return of shoulder function and accept the trade-offs associated with implants. [13–16, 20]
Conclusion
Open reduction and plate fixation of displaced midshaft clavicle fractures produced consistent radiological union and satisfactory functional recovery in this series. Accurate restoration of length and rotation with stable fixation allowed early rehabilitation, significant pain relief and progressive restoration of shoulder motion. Implant prominence remained the principal postoperative nuisance but rarely necessitated immediate reoperation in this cohort. Careful patient selection, meticulous operative technique and frank preoperative counselling about the potential for hardware irritation and possible later removal are essential. Taken together, these results support a selective surgical policy for displaced, shortened or comminuted midshaft clavicle fractures in active adults who seek a predictable and timely return to shoulder function.
References
1. Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures: a multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007; 89:1–10.
2. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968; 58:29–42.
3. Neer CS II. Nonunion of the clavicle. J Am Med Assoc. 1960; 172:1006–1011.
4. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br. 1997; 79:537–539.
5. Nowak J, Holgersson M, Larsson S. Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop. 2005; 76:496–502.
6. McKee MD, Pedersen EM, Jones C, et al. Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am. 2006; 88:35–40.
7. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012; 94:675–684.
8. van der Meijden OA, Houwert RM, Hulsmans M, et al. Operative treatment of dislocated midshaft clavicular fractures: plate or intramedullary nail fixation? A randomized controlled trial. J Bone Joint Surg Am. 2015; 97:613–619.
9. Andrade-Silva FB, Kojima KE, Joeris A, Santos Silva J, Mattar R Jr. Single, superiorly placed reconstruction plate compared with flexible intramedullary nailing for midshaft clavicular fractures: a prospective, randomized controlled trial. J Bone Joint Surg Am. 2015; 97:620–626.
10. Zeng L, Wei H, Liu Y, et al. Titanium elastic nail (TEN) versus reconstruction plate repair of midshaft clavicular fractures: a finite element study. PLoS One. 2015; 10:e0126131.
11. Wilson DJ, Scully WF, Min KS, Harmon TA, Eichinger JK, Arrington ED. Biomechanical analysis of intramedullary vs superior plate fixation of transverse midshaft clavicle fractures. J Shoulder Elbow Surg. 2016; 25:949–953.
12. Ni M, Niu W, Wong DW, Zeng W, Mei J, Zhang. Finite element analysis of locking plate and two types of intramedullary nails for treating midshaft clavicle fractures. Injury. 2016; 47:1618–1623.
13. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. J Orthop Trauma. 2005; 19:504–507.
14. Leroux T, Wasserstein D, Henry P, et al. Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study. J Bone Joint Surg Am. 2014; 96:1119–1125.
15. VanBeek C, Boselli KJ, Cadet ER, Ahmad CS, Levine WN. Precontoured plating of clavicle fractures: decreased hardware-related complications? Clin Orthop Relat Res. 2011; 469:3337–3343.
16. Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg. 2012; 132:617–625.
17. Galdi B, Yoon RS, Choung EW, et al. Anteroinferior 2.7-mm versus 3.5-mm plating for AO/OTA type B clavicle fractures: a comparative cohort study. J Orthop Trauma. 2013; 27:121–125.
18. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures. J Orthop Trauma. 2005; 19:504–507.
19. McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012; 94:675–684.
20. Collinge C, Devinney S, Herscovici D, DiPasquale T, Sanders R. Anterior-inferior plate fixation of middle-third fractures and nonunions of the clavicle. J Orthop Trauma. 2006; 20:680–686.
| How to Cite this Article: Chauhan A, Pradhan C, Patil A, Puram C, Sonawane D, Shyam A, Sancheti P. Functional Outcome of Medial Collateral Ligament Reconstruction Using a SingleTendon Autograft and Suture Anchor: A Prospective Study. Journal of Medical Thesis. 2025 July-December; 11(2):10-13. |
Institute Where Research was Conducted: Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Shivajinagar, Pune, Maharashtra, India.
University Affiliation: MUHS, Nashik, Maharashtra, India.
Year of Acceptance of Thesis: 2022
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Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis: A Prospective Comparison in Distal Tibial Metaphyseal Fractures
Vol 8 | Issue 1 | January-June 2022 | page: 13-16 | Tejas Tribhuvan, Chetan Pradhan, Atul Patil, Chetan Puram, Darshan Sonawane, Ashok Shyam, Parag Sancheti
https://doi.org/10.13107/jmt.2022.v08.i01.176
Author: Tejas Tribhuvan [1], Chetan Pradhan [1], Atul Patil [1], Chetan Puram [1], Darshan Sonawane [1], Ashok Shyam [1], Parag Sancheti [1]
[1] Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
Address of Correspondence
Dr. Darshan Sonawane,
Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
Email : researchsior@gmail.com.
Abstract
Background: Distal tibial metaphyseal fractures pose treatment challenges because of limited soft-tissue coverage and a high risk of wound complications. Choice between intramedullary interlocking nailing and minimally invasive plate osteosynthesis (MIPO) remains controversial; comparative data are needed to guide implant selection.
Methods: In this prospective observational study fifty adult patients with extra-articular distal tibial metaphyseal fractures (AO/OTA 43-A1 to A3) were treated between October 2016 and October 2017. Patients received either intramedullary interlocking nailing (n=25) or MIPO (n=25) according to surgeon decision. Standardised perioperative care, early motion, and radiographic follow-up at 1, 3, 6 and 12 months were applied. Outcomes included time to radiographic union, alignment, complications and functional scores (LEFS, SF-36).
Results: Most fractures united by six months with comparable primary union rates in both groups. Intramedullary nailing was associated with fewer superficial wound issues and earlier mobilisation, while MIPO provided better distal fragment control and lower malalignment rates. Functional outcomes at one year were similar between groups.
Conclusion: Both techniques yield reliable union and comparable one-year function when matched to fracture pattern and soft-tissue status. Implant choice should be individualized, balancing soft-tissue safety and alignment needs.
Keywords: Distal tibia fracture, Intramedullary nailing, Minimally invasive plate osteosynthesis, Union, Alignment
Introduction:
Distal tibial metaphyseal fractures are frequent and present particular management challenges because the bone lies close to the skin and has a limited soft-tissue envelope, increasing the risk of wound complications and infections [1]. These fractures often arise from high-energy trauma such as road traffic accidents and falls, and because the tibia is the main weight-bearing bone of the lower limb, poor treatment may lead to prolonged disability [2]. Historically, rigid open reductions were commonly performed, but recognition of the importance of preserving periosteal and extra osseous blood supply has shifted practice toward less invasive, biology-preserving methods [3]. Two widely used operative options for extra-articular distal metaphyseal fractures are intramedullary interlocking nailing and minimally invasive plate osteosynthesis (MIPO). Intramedullary nailing is a closed, load-sharing approach that tends to preserve soft tissue and permit earlier weight bearing, yet it can be associated with malalignment when distal fragment control is difficult [4]. MIPO allows controlled anatomic reduction of the distal fragment while minimizing periosteal stripping, but plating of the thin distal tibial soft tissues may lead to superficial wound problems or hardware prominence in some patients [5]. Modern technical adjuncts — for nails (blocking/polar screws, improved distal locking) and for plates (anatomic preshaped plates, locking screws) — have narrowed the gap between techniques, though differing complication profiles remain [6, 7]. Given the mixed findings in the literature and the strong influence of fracture morphology and soft-tissue status on outcomes, prospective comparative series are valuable to guide implant selection and to set realistic expectations for patients and surgeons. This study prospectively compares intramedullary nailing and MIPO in a consecutive cohort, focusing on union, alignment, complications and functional recovery to inform patient-centred decision making [8].
Aims & Objectives
To compare intramedullary interlocking nailing and minimally invasive plate osteosynthesis for extra-articular distal tibial metaphyseal fractures with respect to radiographic union, functional recovery, alignment, complications and return to activity.
Review of Literature
Locked intramedullary nailing has a long history in treating metaphyseal tibial fractures, with early series reporting consistent union when careful attention is paid to nail entry and reduction technique to avoid deformity [9]. Subsequent technical developments such as blocking screws and multidirectional distal locking have been described to improve distal control and reduce malalignment, especially in fractures with short distal segments [10, 11]. Several prospective trials compared closed nailing with percutaneous plating and reported mixed outcomes: nailing often showed fewer superficial wound complications and faster early rehabilitation, while plating frequently achieved better restoration of distal alignment when anatomic reduction was possible [12]. The biology of fixation matters: studies of periosteal blood supply demonstrated that open plating techniques can compromise extra osseous circulation, which motivated the MIPO approach to protect biology while achieving stable fixation [13]. Early clinical reports of MIPO described good union rates and functional results, tempered by higher rates of superficial wound problems and implant prominence when soft-tissue handling was suboptimal [14,15]. Comparative observational studies and meta-analyses generally find a pattern — lower superficial infection rates with nailing and lower malalignment rates with plating — but overall differences in long-term function are often modest and heterogeneous across patient subgroups [16,17]. Device innovations (angle-stable nails, anatomically contoured distal plates and locking head screws) have narrowed historical differences, yet the literature repeatedly emphasises tailoring the choice of fixation to fracture geometry, distal fragment size and soft-tissue condition [18, 19]. Classic descriptions and classification schemes remain useful for guiding treatment selection and anticipating pitfalls when the distal segment is very small or the soft tissue envelope is compromised [20].
Materials and Methods
This prospective observational study included fifty consecutive adult patients with extra-articular distal tibial metaphyseal fractures treated at a tertiary teaching hospital between October 2016 and October 2017. Inclusion criteria required skeletally mature patients with fractures limited to the distal tibial metaphysis (AO/OTA 43-A1 to A3); exclusions included intra-articular fractures, pathological fractures, limb-threatening neurovascular injury and Gustilo-Anderson grade III open wounds. Initial management comprised immobilisation, clinical assessment, grading of soft-tissue injury and radiographic evaluation with full-length AP and lateral tibial views including knee and ankle. Treatment allocation — intramedullary interlocking nailing (n=25) or MIPO with distal tibial locking plate (n=25) — followed surgeon decision within uniform institutional protocols. Intramedullary fixation employed closed reduction, reamed interlocking nails and distal locking bolts; plating used percutaneous window insertion of anatomically contoured distal tibial locking plates with locking head screws to minimize periosteal disruption. Standard perioperative antibiotics, sterile technique and wound care were applied. Rehabilitation promoted early knee and ankle range of motion from day one; weight bearing was advanced according to radiographic evidence of callus. Follow-up at 1, 3, 6 and 12 months included clinical review, radiographs and validated functional scoring (Lower Extremity Functional Scale, SF-36). Radiographic union required bridging callus on at least three cortices; delayed union and nonunion used institutional thresholds. Data recorded: demographics, mechanism, fracture classification, time to union, alignment (varus/valgus angulation), complications (wound issues, infection, hardware problems) and secondary procedures. Statistical comparisons used chi-square and t-tests, with p<0.05 considered significant.
Results
Fifty patients were analysed, 25 treated by intramedullary nailing and 25 by MIPO. The mean age was 42.7 years and 76% were male; road traffic accidents were the predominant mechanism. Most fractures united by six months with acceptable primary union rates in both groups. Secondary procedures were required in a minority (approximately 18% overall), with no statistically significant difference between groups. Functional scores (LEFS, SF-36) at one year were comparable and most patients resumed routine activities. Malalignment exceeding 5° was observed more frequently in the nailing group, notably in very distal or comminuted fractures; superficial wound complications and implant prominence occurred more often after plating. Deep infection rates were low in both arms. Knee and ankle ranges of motion at final follow-up were satisfactory across the cohort, though more complex fracture patterns tended to show slightly reduced plantarflexion. Overall, when matched to fracture characteristics and soft-tissue conditions, both techniques achieved acceptable union and functional recovery.
Discussion
This study shows that both intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) can produce good results when the fixation method is chosen to fit the fracture and the soft-tissue condition. Intramedullary nailing has the advantage of a closed, soft-tissue–sparing approach but carries a recognized risk of malalignment when distal fragment control is limited. This risk has been detailed in classic analyses of post-nailing deformity. [1] Randomized and prospective comparisons have reported that nailing often results in fewer superficial wound problems and facilitates earlier mobilisation, while plating can give better restoration of distal alignment when anatomic reduction is achievable. [4, 9]
The biology of fixation matters: studies of extra osseous blood supply and effects of plating helped drive the move toward limited-incision techniques such as MIPO, which aim to protect periosteal circulation while providing stable fixation. [12] Early clinical series describing percutaneous plating reported good union rates but also cautioned about superficial wound issues and hardware prominence if soft-tissue handling is not meticulous. [14,15,16] Practical experience and mechanical evaluations suggest that technical adjuncts — for example, blocking or polar screws with nails and careful plate positioning through small windows — reduce their respective complications and improve alignment control. [11, 18]
Knee pain after tibial nailing is a known complaint and should be discussed with patients when counselling about options. [10] Surgeon judgement is critical: when the distal fragment is large enough to permit secure distal locking and soft tissues are favourable, closed nailing is often an efficient, biological choice; conversely, when the distal segment is very small, comminuted or when precise anatomic reduction is essential, MIPO offers better direct control of alignment. [2, 3, 20]
Device innovations have narrowed historical differences, yet the consistent message across reports is the same — tailor the implant to fracture geometry and soft-tissue status, use meticulous technique, and apply intraoperative adjuncts where needed to minimize the need for secondary procedures. [5–8, 13, 17, 19]
Conclusion
Both intramedullary interlocking nailing and minimally invasive plate osteosynthesis produce reliable union and satisfactory one-year function for extra-articular distal tibial metaphyseal fractures when selected according to fracture characteristics and soft-tissue condition. Intramedullary nailing is less invasive and usually causes fewer superficial wound issues while permitting earlier mobilisation. Minimally invasive plating offers superior control for anatomical reduction of very distal or comminuted fragments, reducing the risk of malalignment when accurate restoration is required.
Careful preoperative planning, gentle soft-tissue handling and intraoperative attention to alignment are essential to minimize complications and deliver predictable outcomes. Surgeon judgement, the thoughtful use of technical adjuncts, and matching the implant to the individual injury produce the best patient results. Larger studies with longer follow-up would help determine whether modest early differences in alignment or wound problems lead to meaningful long-term differences in function or symptoms. Patient counselling and shared decision-making remain essential in practice.
References
1. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res. 1995; 315:25–33.
2. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury. 2011; 42:975–84.
3. Blick SS, Brumback RJ, Lakatos R, et al. Early bone grafting of high-energy tibial fractures. Clin Orthop Relat Res. 1989; 240:21–41.
4. Mauffrey C, McGuinness K, Parsons N, Achten J, Costa ML. A randomized pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. J Bone Joint Surg Br. 2012; 94:704–8.
5. Bisaccia M, Cappiello A, Meccariello L, et al. Nail or plate in the management of distal extra-articular tibial fracture, what is better? Valutation of outcomes. SICOT-J. 2018; 4(2).
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9. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomized trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010; 92-B: 984–988.
10. Court-Brown CM, Gustilo T, Shaw AD. Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma. 1997; 11:103–105.
11. Yong Li, Lei Liu, Xin Tang, et al. Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop (SICOT). 2012; 36:1457–1462.
12. Borrelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002; 16(10):691–695.
13. Fisher WD, Hamblen DL. Problems and pitfalls of compression fixation of long bone fractures: a review of results and complications. Injury. 1978; 10(2):99–107.
14. Borg T, Larsson S, Lindsjö U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004; 35(6):608–614.
15. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury. 2006; 37(9):877–887.
16. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury. 2004; 35(6):615–620.
17. Mosheiff R, Safran O, Segal D, Liebergall M. The unreamed tibial nail in the treatment of distal metaphyseal fractures. Injury. 1999; 30:83–90.
18. Hoenig M, Gao F, Kinder J, Zhang LQ, Collinge C, Merk BR. Extra-articular distal tibia fractures: a mechanical evaluation of four different treatment methods. J Orthop Trauma. 2010; 24:30–35.
19. Schmidt AH, Finkemeier CG, Tornetta III P. Treatment of closed tibial fractures. Instr Course Lect. 2003; 52:607–622.
20. Robinson CM, McLauchlan GJ, and McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle: classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br. 1995; 77:781–787.
| How to Cite this Article: Tribhuvan T, Pradhan C, Patil A, Puram C, Sonawane D, Shyam A, Sancheti P. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis: A Prospective Comparison in Distal Tibial Metaphyseal Fractures. Journal of Medical Thesis. 2022 January-June; 08(1):13-16. |
Institute Where Research was Conducted: Sancheti Institute of Orthopaedics and Rehabilitation PG College, Sivaji Nagar, Pune, Maharashtra, India.
University Affiliation: Maharashtra University of Health Sciences (MUHS), Nashik, Maharashtra, India.
Year of Acceptance of Thesis: 2019
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