Intramedullary Nailing versus Internal Plate Fixation in the Repair of Open, Distal Tibial Fractures with Articular...

Open distal tibial fractures with articular involvement (ODTFAI) are complex injuries, but there is little consensus regarding whether intramedullary nailing (IMN) or internal plate fixation (IPF) is better suited to their repair.

The aim of this study is to compare IMN against IPF in ODTFAI repair to determine which yields better outcomes.

Retrospective cohort study.

A retrospective analysis was conducted, using patient data collected between April 2015 and December 2023, at a major tertiary center. Forty-nine adult patients with open AO/OTA 43-C fractures were included. Twenty-five had been treated with IMN and twenty-four had been treated with IPF. The incidence of complications was the primary outcome. Secondary outcomes included time to weight-bearing and time to radiographic union.

Complication rates were significantly higher in the IPF group (IMN = 24 %, IPF = 54 %, p = 0.032). Amputation rates were lower in the IMN group (IMN = 0 %, IPF = 17 %, p = 0.035 respectively). The mean OTA arterial score was higher in the IMN group (IMN = 1.20, IPF = 1.00, p = 0.032). The proportion of cases returning to theater was higher in the IPF group than in the IMN group (IMN = 8 %, IPF = 50 %, p = 0.001).

Complications may be more likely when ODTFAI are treated with IPF. Fewer patients experienced a return to theater and failed limb salvage following nail stabilization. IMN could be more suited to the repair of open articular distal tibial fractures, thus leading to better outcomes for patients.