To compare the outcome of intramedullary nailing and locking compression plate fixation in treatment of proximal one third tibia fracture: A randomized control trial
Keywords:
Intramedullary nailing (IMN), Proximal tibial locking compression plate (PLCTP), Proximal tibial extraarticular fractures, Prospective trial
Abstract
Background: Fractures of tibia shaft are most common of long bone fractures. Proximal tibia fractures account for approximately 5% to 11% of all tibial injuries and affect knee function and stability in most of the cases. Higher rates of malunion and increased incidence of associated complications have made these fractures particularly problematic. In recent years due to advancement in technique, proximal tibia plating and multidirectional locked intramedullary nailing, both have become widely used treatment modalities for proximal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures.
Materials and methods: This randomized prospective clinical study was conducted on 62 skeletally mature patients with closed extra-articular fracture of the proximal tibia treated with proximal tibial locking compression plating (PTLCP) or intramedullary nailing (IMN) by expert surgeons at a tertiary trauma center.
Results: Postoperative hospital stay (p = 0.043), postoperative infection rate (p = 0.036) were significantly high in the PTLCP group than in the IMN group, while rate of malunion (p=0.041) and nonunion(0.037) were significantly high in IMN group than in PTLCP group. However there was no clear advantage of either technique in terms of functional recovery of knee.
Conclusion: Present comparison of IMN and PTLCP for the treatment of proximal one third tibia fracture showed no clear advantage of either technique. Present study concluded that both forms of treatment (IMN and PTLCP) provide adequate fracture stability. Level of evidence: Level 2, randomized controlled trial.
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References
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2. DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A 10-year followup study. Clin Orthop Relat Res. 1988;231:196–04.
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8. Matthews DE,McGuire R, Freeland AE. Anterior unicortical buttress platting in conjunction with an undreamed intramedullary nail for treatment of very
proximal tibial diaphyseal fractures. Orthopedics. 1997 Jul;20(7):647-8
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10. Stannard JP, Wilson TC, Volgas DA, Alonso JE, Minimally Invasive Percutaneous Plate Osteosynthesis Of Proximal Tibial Fractures Using Locking Compression Plate – A Prospective Study ,Injury, 2003 Aug; Vol. 34 Suppl 1, pp. A36-42
11. Ricci W.M., O'Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking
screws. J Orthop Trauma. 2001 May;15(4):264-70
12. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximalN tibia fractures (OTA types 41): the results of a
prospective, standardized protocol. J Orthop Trauma. 2005 Aug;19(7):448-5
13. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibial fractures with LISS, J Orthop Trauma. 2004 Sep;18(8):521-7
14. Schutz M, Kaab MJ, Haas N. Stabilization of proximal tibia fractures with the LIS-System: early clinical experience in Berlin. Injury. 2003;34(Suppl1):A30–A35. doi: 10.1016/S0020-1383(03)00255-9
15. Boldin C, Finkahauser F, Hofer HP, et al. Three year results of proximal tibia fracture treated with LISS. Clin Orthop Relat Res. 2006 Apr;445:222-9.
16. Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, et al. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma. 2006;20(8):523–28. doi: 10.1097/01.bot.0000244993.60374.d6.
17. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43-9.
18. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal
tibial fractures: comparison of 56 cases. J Orthop Trauma. 2009;23:485–92. doi: 10.1097/BOT.0b013e3181b013d2.
19. Müller, M.E., Nazarian, S., Koch, P. et al, The comprehensive classification of fractures of long bones. in: 1st ed. Berlin. Springer-Verlag, Heidelberg, New
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20.Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res.1995 Jun;(315):25-33
21. Koval K, Clapper M, Brumback R, et al. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 1991;5(2):184–9. doi:10.1097/00005131-199105020-00011.
22. Vidyadhara S. Sharath K. Rao. Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fracture. Int. J. Care
Injured (2006)37; 536-42
23. Fan Liu, Ran Tao, Yi Cao, Youhua Wang, Zhenyu Zhou, Hong Wang,YongqiangGu. The role of LISS (less invasive stabilisation system) in the treatment of peri-knee fractures. Province, PR China.Injury. 07/2009; 40(11):1187-4
24. Singh V.K.,1 Y Singh,2 PK Singh,3 RK Goyal,2 H Chandra2 Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws
for proximal third tibial fractures Journal of Orthopaedic Surgery 2009;17(1):23-7
25. Lang GJ, Cohen BE, Bosse MJ, Kellam JF. Proximal third tibial shaft fractures. Should they be nailed? ClinOrthopRelat Res. 1995 June;(315):64-74
26. Tornetta P, Collons E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res. 1996;328:185–9. doi:
10.1097/00003086-199607000-00029.
27. Dunbar RP, Nork SE, Barei DP, Mills WJ. Provisional plating of Type III open tibia fractures prior to intramedullary nailing. J Orthop Trauma. 2005 Jul;19(6):412
28. Krettek C, Stephan C, Schandelmaier P, et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter
intramedullary nails. J Bone Jt Surg Br. 1999;81:963–8.doi: 10.1302/0301-620X.81B6.10000.
29. Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixation pin distractor technique. J Orthop Trauma. 1994;8(3):195–
202. doi: 10.1097/00005131-199406000-00003
30. Henley MB, Meier M, Tencer AF. Influences of some design parameters on the biomechanics of the unreamed tibial intramedullary nail. J Orthop Trauma.
1993;7(4):311–9. doi: 10.1097/00005131-199308000-00003.
31. Oh CW, Oh JK, Kyung HS, Jeon IH, Park BC, Min WK, Kim Pt. Minimally Invasive Percutaneous Plate Osteosynthesis Of Proximal Tibial Fractures Using
Locking Compression Plate – A Prospective Study. ActaOrthopaedica [ActaOrthop], ISSN: 1745-3674,2006 Jun; Vol. 77 (3), pp. 524-30;
32. Bolhofner BR. Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res. 1995 Jun;(315):75-83
33. Bhandari M, Audige L, Ellis T. Operative treatment of extraarticular proximal tibial fractures. J Orthop Trauma. 2003;17(8):591–5. doi: 10.1097/00005131-
200309000-00013.
34. Kim J. W., Chang-Wug Oh, corresponding authorWon-Ju Jung, MD, and Ji-Soo Kim, MD Minimally Invasive Plate Osteosynthesis for Open Fractures of the Proximal Tibia ClinOrthop Surg. 2012 December; 4(4):313–20.
2. DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A 10-year followup study. Clin Orthop Relat Res. 1988;231:196–04.
3. Peindl RD, Zura RD, Vincent A et al. Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation. J Orthop Trauma. 2004 Sep;18(8):540-5.
4. Laflamme GY, Heimlich D, Stephen D, Kreder HJ, Whyne CM Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma. 2003 Aug;17(7):496-02.
5. Tornetta P, Collons E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res. 1996;328:185–9. doi: 10.1097/00003086-199607000-00029
6. Krettek C, Stephan C, Schandelmaier P, et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter
intramedullary nails. J Bone Jt Surg Br. 1999;81:963– 68. doi: 10.1302/0301-620X.81B6.10000.
7. Beuhler KC, Green J, Woll TS, Duwelius PJ. A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma. 1997;11(3):218–23. doi: 10.1097/00005131-199704000-00014
8. Matthews DE,McGuire R, Freeland AE. Anterior unicortical buttress platting in conjunction with an undreamed intramedullary nail for treatment of very
proximal tibial diaphyseal fractures. Orthopedics. 1997 Jul;20(7):647-8
9. Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma.2004;18(8):528–35. doi: 10.1097/00005131-200409000-00008.
10. Stannard JP, Wilson TC, Volgas DA, Alonso JE, Minimally Invasive Percutaneous Plate Osteosynthesis Of Proximal Tibial Fractures Using Locking Compression Plate – A Prospective Study ,Injury, 2003 Aug; Vol. 34 Suppl 1, pp. A36-42
11. Ricci W.M., O'Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking
screws. J Orthop Trauma. 2001 May;15(4):264-70
12. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximalN tibia fractures (OTA types 41): the results of a
prospective, standardized protocol. J Orthop Trauma. 2005 Aug;19(7):448-5
13. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibial fractures with LISS, J Orthop Trauma. 2004 Sep;18(8):521-7
14. Schutz M, Kaab MJ, Haas N. Stabilization of proximal tibia fractures with the LIS-System: early clinical experience in Berlin. Injury. 2003;34(Suppl1):A30–A35. doi: 10.1016/S0020-1383(03)00255-9
15. Boldin C, Finkahauser F, Hofer HP, et al. Three year results of proximal tibia fracture treated with LISS. Clin Orthop Relat Res. 2006 Apr;445:222-9.
16. Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, et al. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma. 2006;20(8):523–28. doi: 10.1097/01.bot.0000244993.60374.d6.
17. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43-9.
18. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal
tibial fractures: comparison of 56 cases. J Orthop Trauma. 2009;23:485–92. doi: 10.1097/BOT.0b013e3181b013d2.
19. Müller, M.E., Nazarian, S., Koch, P. et al, The comprehensive classification of fractures of long bones. in: 1st ed. Berlin. Springer-Verlag, Heidelberg, New
York; 1990. [Crossref]
20.Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res.1995 Jun;(315):25-33
21. Koval K, Clapper M, Brumback R, et al. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma. 1991;5(2):184–9. doi:10.1097/00005131-199105020-00011.
22. Vidyadhara S. Sharath K. Rao. Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fracture. Int. J. Care
Injured (2006)37; 536-42
23. Fan Liu, Ran Tao, Yi Cao, Youhua Wang, Zhenyu Zhou, Hong Wang,YongqiangGu. The role of LISS (less invasive stabilisation system) in the treatment of peri-knee fractures. Province, PR China.Injury. 07/2009; 40(11):1187-4
24. Singh V.K.,1 Y Singh,2 PK Singh,3 RK Goyal,2 H Chandra2 Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws
for proximal third tibial fractures Journal of Orthopaedic Surgery 2009;17(1):23-7
25. Lang GJ, Cohen BE, Bosse MJ, Kellam JF. Proximal third tibial shaft fractures. Should they be nailed? ClinOrthopRelat Res. 1995 June;(315):64-74
26. Tornetta P, Collons E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res. 1996;328:185–9. doi:
10.1097/00003086-199607000-00029.
27. Dunbar RP, Nork SE, Barei DP, Mills WJ. Provisional plating of Type III open tibia fractures prior to intramedullary nailing. J Orthop Trauma. 2005 Jul;19(6):412
28. Krettek C, Stephan C, Schandelmaier P, et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter
intramedullary nails. J Bone Jt Surg Br. 1999;81:963–8.doi: 10.1302/0301-620X.81B6.10000.
29. Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixation pin distractor technique. J Orthop Trauma. 1994;8(3):195–
202. doi: 10.1097/00005131-199406000-00003
30. Henley MB, Meier M, Tencer AF. Influences of some design parameters on the biomechanics of the unreamed tibial intramedullary nail. J Orthop Trauma.
1993;7(4):311–9. doi: 10.1097/00005131-199308000-00003.
31. Oh CW, Oh JK, Kyung HS, Jeon IH, Park BC, Min WK, Kim Pt. Minimally Invasive Percutaneous Plate Osteosynthesis Of Proximal Tibial Fractures Using
Locking Compression Plate – A Prospective Study. ActaOrthopaedica [ActaOrthop], ISSN: 1745-3674,2006 Jun; Vol. 77 (3), pp. 524-30;
32. Bolhofner BR. Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res. 1995 Jun;(315):75-83
33. Bhandari M, Audige L, Ellis T. Operative treatment of extraarticular proximal tibial fractures. J Orthop Trauma. 2003;17(8):591–5. doi: 10.1097/00005131-
200309000-00013.
34. Kim J. W., Chang-Wug Oh, corresponding authorWon-Ju Jung, MD, and Ji-Soo Kim, MD Minimally Invasive Plate Osteosynthesis for Open Fractures of the Proximal Tibia ClinOrthop Surg. 2012 December; 4(4):313–20.
CITATION
DOI: 10.17511/ijmrr.2016.i02.020
Published: 2016-02-29
How to Cite
1.
Jain S, Verma R, Gaur S, Gohiya A. To compare the outcome of intramedullary nailing and locking compression plate fixation in treatment of proximal one third tibia fracture: A randomized control trial. Int J Med Res Rev [Internet]. 2016Feb.29 [cited 2024Apr.24];4(2):245- 253. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/466
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Original Article
OAI - Open Archives Initiative
