Minimally-Invasive Plate or Intramedullar Nail in the Management of Distal Extra-Articular Tibial Fracture, What Is Better?

Öz

Objective: The aim of this study was to compare the clinical and functional outcomes of patients with distal tibia extraarticular fractures treated with Intramedullary nailing (IMN) or Minimally invasive plate osteosynthesis (MIPO).
Materials and Methods: This retrospective study included 47 patients treated with IMN and 41 patients with MIPO. Clinical and radiographic results were evaluated at last follow-up. Anterior knee pain, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score and Lysholm knee scoring scale were used as clinical measurement.
Results: Although the union time and operation time were significantly higher in the IMN group compared to the MIPO group (p<0.001), the full weight bearing time and the hospital time were higher in the MIPO group (p<0.001). There were no statistical differences between wound problem, malposition, infection and grafting rates in both groups (p>0.05). Although the AOFAS score was statistically higher in the IMN group (p=0.031), the Lysholm knee score was higher in the MIPO group (p<0.001).
Conclusion: While MIPO is advantageous with low union time, low operating time and no damage to the knee joint, IMN allows earlier full weight bearing, lower hospitalization and has better ankle functional results.
Keywords: 

Anahtar Kelimeler

• Distal tibial fractures
• intramedullary nail
• minimally invasive plate osteosynthesis

Distal Ekstra-Artiküler Tibia Kırığının Tedavisinde Minimal İnvaziv Plak veya İntramedüller Çivi, Hangisi Daha İyi?

Öz

Amaç: Bu çalışmanın amacı, intramedüller çivileme (IMN) veya minimal invaziv plak osteosentezi (MIPO) ile tedavi edilen distal tibia ekstraartiküler kırıklı hastaların klinik ve fonksiyonel sonuçlarını karşılaştırmaktır.
Materyal ve Metot: Bu retrospektif çalışma, IMN ile tedavi edilen 47 hastayı ve MIPO ile tedavi edilen 41 hastayı içermektedir. Klinik ve radyografik sonuçlar son takipte değerlendirildi. Klinik ölçüm olarak ön diz ağrısı, Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) Ayak Bileği-Arka Ayak Ölçeği puanı ve Lysholm diz puanlama ölçeği kullanıldı.
Bulgular: İki gruptaki hiçbir hastada kaynamama geliştirmedi. IMN grubunda kaynama süresi ve operasyon süresi MIPO grubuna göre anlamlı olarak daha yüksek olmasına rağmen (p<0,001), MIPO grubunda tam yük taşıma süresi ve hastanede kalma süresi daha yüksekti (p<0,001). Gruplar arasında yara sorunu, yanlış pozisyon, enfeksiyon ve greftleme oranları açısından istatistiksel olarak fark yoktu (p>0,05). AOFAS skoru IMN grubunda istatistiksel olarak daha yüksek olmasına rağmen (p=0,031), Lysholm diz skoru MIPO grubunda daha yüksekti (p<0,001).
Sonuç: MIPO, erken kaynama, kısa operasyon süresi ve diz eklemine zarar vermemesi ile avantajlıyken, IMN daha erken tam yük taşımaya, daha kısa hastanede yatmaya ve daha iyi ayak bileği fonksiyonel sonuçları elde etmeyi sağlamaktadır.

Anahtar Kelimeler

• Distal tibia kırıkları
• intramedüller çivi
• minimal invaziv plak osteosentezi

Kaynakça

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