Comparative Study of Minimally Invasive Plate Osteosynthesis (MIPO) Versus Intramedullary Nailing for Distal Third Tibial Shaft Fractures: A Prospective Analysis of Soft Tissue Healing and Union Rates

Background: The distal third tibial shaft fracture is one of the most difficult orthopedic injuries, due to poor soft tissue cover, vascularity and close proximity with the ankle joint. The ultimate goal of surgical fixation is to meet these objectives: safe, predictable fracture union and to maintain the integrity of soft tissues, with a minimal rate of complications. The two most commonly used fixation techniques are minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN). Both techniques have been shown to have satisfactory clinical results but there is some debate about their relative effectiveness in healing fractures, preserving soft tissue, malalignment and functional recovery. The objective is to compare the functional outcomes, complication rate, the time of fracture union and soft tissue healing for minimally invasive plate osteosynthesis versus intramedullary nailing in the treatment of distal third tibial shaft fractures. Material and Methods: This was a prospective comparative study of 112 adult patients with distal third tibial shaft fractures over 2 years at IMS and SUM hospital, Bhubaneswar. There were 56 patients treated with minimally invasive plate osteosynthesis and 56 patients treated with intramedullary nailing. This at least 12-months follow-up assessed demographic and injury profile and operative variables, soft tissue healing, radiological fusion, complications, and functional outcome. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. A multivariate analysis was conducted to see if any other factors predicted delayed union. Results: In the MIPO group, 53 patients (94.6%) had radiological union while 51 patients (91.1%) had IMN union. Treatment using MIPO showed to improve significantly the soft tissue healing, the rate of wound complication, and the fracture alignment, while intramedullary nailing showed to be associated with a shorter duration of surgery and earlier partial weight bearing. There were no significant differences between the two groups at 1 year in functional outcomes. Conclusion: Forearm fractures of the distal third of tibia were treated with satisfactory clinical and radiological results with both methods. The clinical and radiological results of both MIPO and intramedullary nailing was satisfactory for distal third tibial shaft fractures. MIPO preserved the soft tissues better and aligned the fracture more, whereas IMN had a more rapid operative time and mobilization. Surgical technique should be tailored to the fracture and patient.

Keywords: Distal tibial fracture, Minimally invasive plate osteosynthesis, Intramedullary nailing, Fracture union, Soft tissue healing, Prospective study.