Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: A multi-centre study

Concomitant plate fixation as an adjunct to intramedullary nailing (IMN) of proximal third tibia fractures is a proven technique. Benefits include its role as a minimally invasive reduction aid, allowing for minimal soft tissue disruption. Expanding its indications as adjunct fixation to IMN throughout the tibia, we aimed to study outcomes in a multi-centre initiative.

From May 1999 to March 2010, a total of 1302 operatively treated tibial fractures (including plateau and pilon fractures) with complete medical records were identified for review. Of these, 376 cases were treated via IMN, of which 30 cases were treated via combined IMN and plating, meeting inclusion criteria. Primary outcome was union rates, time to union, and complication rates. Secondary outcomes included mean alignment from the immediate postoperative period to the time of final follow-up.

Twenty-seven out of 30 patients were available for follow-up. Twenty-five (93%) achieved bony union; the remaining two patients, sustained Type IIIA and B injuries respectively, went onto non-union secondary to deep infection and required multiple re-operations before achieving ultimate union. Mean time at final follow-up was 20 ± 10 months, 96% were ambulatory at full weight bearing status with no malunions. No significant changes in alignment in either the coronal or sagittal planes were noted at time of final follow-up.

Combined IMN and plate fixation is a reliable tool not only in the treatment of fractures of the proximal tibia, but also for those fractures in the diaphysis and segmental fractures with proximal and/or distal metadiaphyseal extension with consistent ability to maintain high union rates and maintained alignment. However, longer-term follow-up and prospective trials will be necessary before coming to a definitive conclusion.