Extraparticular distal metaphyseal fractures of the tibia: percutaneous plate vs. Intramedullary nail

Fracturas metafisarias distales extraparticulares de tibia: Placa percutánea vs. Clavo endomedular

In the management of distal diaphyseal tibial fractures there is still controversy about which surgical technique offers the greatest benefits. The aim of this work is to describe and compare the used, intramedullary nail and percutaneous plate, and the results regarding consolidation and complications, in patients treated between January 2004 and May 2008 at the Hospital de San José and a third level associate institution of attention. We describe a historical cohort of 55 patients with 12-month follow-up. 76.4% of the population was male with an average age of 36 years. A higher percentage of poor union was observed in the patients who underwent CE (10.7% vs. 7.4%, RR 1.45). The consolidation was presented in 92.9% (26/28) of the patients managed with CE versus 88.9% (24/27) of those with PP. Pseudoarthrosis was found in two treated with CE and in three with PP (7.1% vs. 11.1%, RR 0.64). The failure of the osteosynthesis material was not observed with the use of CE, while two with PP presented the event (0% vs. 7.4%). In each group, two cases of infection were seen (7.1% vs. 7.4%). Reoperation was required in 17.9% (5/28) with CE and in 25.9% (7/27) with PP. The management with EC although it shows a higher index of bad union than with the use of PP, would show a higher percentage of consolidation and some complications and minor reoperation. Future multi-center studies are required to demonstrate differences between the two types of treatments. Abbreviations: CE, intramedullary nail; PP, percutaneous plate.

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