Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial

Ramesh Chand Meena, Umesh Kumar Meena, Gopal Lal Gupta, Nitesh Gahlot, Sahil Gaba, Ramesh Chand Meena, Umesh Kumar Meena, Gopal Lal Gupta, Nitesh Gahlot, Sahil Gaba

Abstract

Background: Extra-articular proximal tibial fractures account for 5-11 % of all tibial shaft fractures. In recent years, closed reduction and minimally invasive plating and multidirectional locked intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures.

Materials and methods: This randomized prospective clinical study was conducted on 58 skeletally mature patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive proximal tibial plating (PTP) or intramedullary nailing (IMN) by trained surgeons at a tertiary trauma center.

Results: Postoperative hospital stay (p = 0.035), time to full weight-bearing, and union time (p = 0.004) were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time (p = 0.082), infection rate (p = 0.738), range of motion of the knee (p = 0.462), or degrees of malunion and nonunion.

Conclusion: Both implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse.

Level of evidence: Level 2, randomized controlled trial.

Figures

Fig. 1
Fig. 1
Patient with a segmental tibial fracture treated with expert tibial nail, showing a good range of motion of the knee postoperatively
Fig. 2
Fig. 2
Preoperative and postoperative radiographs of a patient treated with plating

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