# Prospective Comparative Study of Functional Outcomes of Distal Extra-articular Tibia Fracture Fixed With Intramedullary Nailing Versus Locking Compression Plating

## TL;DR

This study compares two surgical methods for treating tibial fractures and finds similar long-term outcomes but different short-term benefits.

## Contribution

A prospective comparative analysis of intramedullary nailing versus locking compression plating for distal tibial fractures with functional and radiological outcomes.

## Key findings

- Both IMN and LCP achieved full fracture healing with good to excellent outcomes in most patients.
- IMN showed shorter operative time and fewer complications compared to LCP.
- Long-term functional outcomes were similar between the two groups.

## Abstract

Introduction

Distal tibial fractures are prevalent long bone injuries that pose difficulties owing to insufficient soft tissue coverage and their closeness to the ankle joint. The selection of the fixing method continues to be contentious, especially for extra-articular fractures. This study sought to investigate extra-articular distal tibial fractures, compare intramedullary nailing (IMN) with minimally invasive plate osteosynthesis (MIPO), evaluate their clinical, radiological, and functional outcomes, and identify the problems linked to each procedure.

Methodology

This prospective comparative study was conducted from March 2022 to March 2025 and involved 40 patients with extra-articular distal tibial fractures. Patients were categorized into two cohorts: 20 received IMN and 20 underwent locking compression plating (LCP). The average patient age was 42.2 years in the IMN group and 49.1 years in the LCP group. Both genders were represented, and laterality was nearly equilibrated. Patients received assessments prior to, during, and following the operation. A clinical examination was conducted with the American Orthopaedic Foot & Ankle Society (AOFAS) score, and radiological evaluation was carried out through X-ray imaging. Functional outcome was assessed using the AOFAS ankle-hindfoot score (pain 40, function 50, alignment 10; total 100). Outcomes were categorized as excellent (>90), good (81-90), fair (71-80), and poor (<70).

Results

At the one-year follow-up, all fractures had healed. In the IMN group, seven patients (35%) attained outstanding outcomes, whereas 13 patients (65%) received good outcomes. Within the LCP cohort, four (20%) patients achieved great outcomes, 12 (60%) attained good outcomes, three (15%) experienced fair outcomes, and one (5%) exhibited a bad outcome. Complications arose in four patients in the LCP group (two superficial wound infections, one deep infection, and one persistent ankle soreness) and in two patients in the IMN group (both superficial wound infections). No malunion or nonunion was detected. Good outcome in this study refers to an AOFAS score between 81 and 90 at the 12-month follow-up.

Conclusion

IMN and LCP yielded advantageous long-term results for extra-articular distal tibial fractures. IMN exhibited benefits in reduced operational duration, diminished complications, and enhanced functional outcomes during the early follow-up phase, however long-term results were similar across groups. More extensive investigations with prolonged follow-up are required to corroborate these results.