Intramedullary Nail Versus Minimally Invasive Plate Osteosynthesis for Displaced Extraarticular Proximal Tibia Fractures: A Prospective Comparative Cohort Study Publisher Pubmed

Summary: Study compares MIPO vs. IMN for tibial fractures. IMN yielded faster union times and better outcomes, though higher knee pain. Is IMN the better choice? #Orthopedics #FractureHealing

Teimouri M¹ ; Mirghaderi P² ; Parry JA³ ; Ziaei A⁴ ; Salimi M⁵ ; Tahririan MA¹
Source: European Journal of Orthopaedic Surgery and Traumatology Published:2023

Abstract

Purpose: The treatment of extraarticular proximal tibial fractures is challenging. As the optimal fixation technique is still debated, the purpose of this study was to compare minimally invasive plate osteosynthesis (MIPO) and intramedullary nail (IMN) fixation. Methods: A prospective matched comparative study was conducted on patients with displaced extraarticular proximal tibia fractures treated with MIPO (n = 29) versus IMN (n = 30) fixation. Outcomes collected were the Johner–Wruhs grading, range of motion (ROM), union rate, time to union, malunion, coronal and sagittal alignment, and post-operative complications. Results: Union rates were similar between the MIPO and IMN groups (93% vs. 97%, P = 1.0). The IMN group had an earlier time to union (15 vs. 18 weeks, P < 0.001) and superior functional outcomes at one year (effective Johner–Wruhs score: 80% vs. 55%, P = 0.04). There was a significantly higher incidence of anterior knee pain in the IMN group (23% vs. 0%, P = 0.02) and there was a trend for more infections in the MIPO group (21% vs. 13%, P = 0.73). Conclusion: IMN fixation of extraarticular proximal tibia fractures was associated with a shorter union time and better functional scores compared to MIPO. © 2023, The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.