A retrospective clinical comparative study of intramedullary nailing and minimally invasive plate osteosynthesis for extra-articular distal tibia fractures

The treatment of extra-articular distal tibia fractures is a difficult challenge. Minimally invasive plating osteosynthesis (MIPO) and intramedullary nailing (IMN) are satisfactory extra-articular distal tibia fractures. The optimal surgical treatment for extra-articular distal tibia fractures remains controversial. The purpose of this retrospective study was to compare the clinical and functional outcomes of patients with extra-articular distal tibia fractures treated with MIPO or IMN. For this retrospective study, a total of 266 patients with closed extra-articular distal metaphysis (OA type 43-A) or closed distal tibial fracture (AO type 42) were enrolled and included; 110 patients were treated with MIPO, and 156 patients underwent IMN. There was no significant difference in the primary operation union rate, AOFAS score, deep surgical site infection or malalignment between the MIPO and IMN groups. However, there was a longer operation time, more prospective times, more intraoperative blood loss and more frequent anterior knee pain in the IMN groups than in the MIPO group. There was a significantly shorter time to union in the IMN group than in the MIPO group (138.8 ± 11.0 vs. 153.5 ± 17.1 days, p < 0.05) and a lower superficial surgical site infection in the IMN group than in the MIPO group (1.9% vs. 8.2%, p < 0.05). We found that extra-articular distal tibia fractures can be treated satisfactorily with IMN or MIPO. Pollor blocking screws have a main role in improving the efficacy of IMN. Regardless of the operation time, intraoperative blood loss and occurrence of anterior knee pain, IMN was recommended as the choice to treat extra-articular distal tibia fractures.