Comparison Between Intramedullary Nailing and Plating in Diaphyseal Tibial Fractures with Intact Fibula: Randomized Controlled Trial

Abstract

Aim: To compare between intramedullary nailing and plating in diaphyseal tibial fractures with intact fibula Study design: Randomized controlled trial Place and duration: This study was conducted at Pakistan Institute of Medical Sciences Islamabad, Pakistan from February 2020 to February 2021. Methodology: During these two years of study period, 1470 limb fracture patients were treated at our institute from which 114 were qualified to participate in this study. A total of 73 patients who were eligible for the experiment were enrolled, and a total of 69 of them were monitored for at least a year. Plating fractures and intramedullary nailing are both common surgical methods that may be used in the treatment of fractures in the femur. Patients' reports of pain or discomfort in the limb were significant predictors of failure in both therapies. We monitored the factors including the length of surgery, the quantity of blood lost, and the time it took to accomplish union. Results: Intramedullary nailing resulted in a single nonunion (P = 0.285) and one patient developed a late, deep infection in the screw position (P = 0.478), which was cured by screw removal. Although the intramedullary group required more procedures to accomplish union, the tibial fractures in both groups were healed in around 4 months (dynamization was done in 4 patients, representing 12.1% of the total, P = 0.047). Two patients in the intramedullary group (6.1%) and four patients in the plate group (11.1%) had implants removed during the follow-up period, which was not statistically significant (P = 0.675). A statistically significant difference between the two groups was found only when it came to the number of patients reporting limb pain and the number of people reporting knee discomfort (P = 0.001). The plate group included 29 patients with no complaints, whereas the intramedullary group had 18 patients (54.4%) with no complaints and 13 patients (39.5%) with knee discomfort. Conclusion: Both methods are suitable treatments for closed noncomminuted solitary tibial fractures, as per the findings of this study; moreover, patients who receive intramedullary nails are more likely to require additional operations to achieve union and to complain of discomfort in their limbs or knees. Keywords: tibial fracture, nailing, bone plates, intramedullary