Evaluating Fixation Strategies for Ultra-Distal Tibial Fractures: A Comparative Analysis of Plate and Nail Techniques
DOI:
https://doi.org/10.65761/pjcr.2025.2.1.3Keywords:
Ultra-distal tibial fractures, internal fixation, distal tibial plating, intramedullary nailing, comparative studyAbstract
The management of ultra-distal tibial fractures which affect both the distal tibia's metaphyseal and epiphyseal areas remains difficult because of the difficult surgical anatomy combined with minimal bone availability together with exposed soft tissue. Multiple treatment options need careful evaluation for fixing these types of fractures to achieve the best results. The research compares the surgical results between distal tibial plate fixation and intramedullary nail fixation used for ultra-distal tibial fracture treatment. A research study used retrospective data from the Orthopedic Department of General Hospital Lahore during a period of February 2023 to August 2024. Two treatment groups included Group A (n=40) whose patients underwent distal tibial plating while Group B (n=40) received intramedullary nailing for their ultra-distal tibial fractures. This study examined union time along with malalignment measurement and functional outcomes using AOFAS score and recorded operative time and hospital stay period and complications between the two patient groups. The durations until bone union were similar between both groups as patients in the plating group needed 16.2±2.4 weeks while patients with nailing required 15.1±2.1 weeks (p=0.12). The plating group sustained malalignment in 5.6% of cases while the nailing group developed malalignment in 17.6% of cases (p=0.24). The patients in the plating group demonstrated AOFAS scores of 87.3 ± 6.8 which were comparable to those of 84.7±7.5 found in the nailing group (p=0.21). Patients underwent surgeries and hospitalization for shorter durations in the nailing group when compared to the plating group (p<0.05). Wound complications from the surface of the bone occurred more frequently in patients treated with plating techniques while hardware irritation developed more often in patients with nailing procedures. Both distal tibial plating and intramedullary nailing are effective options for managing ultra-distal tibial fractures. Plating offers better alignment control, while nailing provides advantages in surgical efficiency and early rehabilitation. The choice of fixation method should be based on fracture characteristics, soft tissue condition, and surgeon expertise.
References
1. Gonçalves, G. S. Y., de Magalhães, K. M. F., Rocha, E. P., Dos Santos, P. H., & Assunção, W. G. J. C. o. i. (2022). Oral health- related quality of life and satisfaction in edentulous patients rehabilitated with implant-supported full dentures all-on- four concept: A systematic review. 1-12.
2. Martins, A. A., de Pontes, V. O. L., Clemente, L. M., Ribeiro, A. B., Muglia, V. A., & Silva-Lovato, C. H. J. R. D. (2024). Quality of life in edentulous patients: the role of dentures. 17(59), e1965-e1965.
3. Bida, C., Virvescu, D. I., Bosinceanu, D. N., Luchian, I., Fratila, D., Tunaru, O., . . . Education, D. (2024). ADVANCES IN DENTAL PROSTHETICS: THE ROLE OF CAD/CAM TECHNOLOGY IN DENTURE FABRICATION. 13(1).
4. Kutkut, A., Knudson, H., Bush, H., & Studts, J. J. J. o. O. I. (2024). Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics.
5. Budală, D. G., Lupu, C. I., Vasluianu, R. I., Ioanid, N., Butnaru,
O. M., & Baciu, E.-R. J. M. (2023). A contemporary review of clinical factors involved in speech-perspectives from a prosthodontist point of view. 59(7), 1322.
6. Sethi, A., Haq, M. A., Zaidi, S. J. A., & Baig, Q. A. J. B. M. E.
(2024). Developing entrustable professional activities for undergraduate operative dentistry clerkship. 24(1), 1505.
7. Durey, A., Lette, H., Saunders, J., Slack‐Smith, L. J. H., & Community, S. C. i. t. (2022). Community‐centred oral healthcare for adults experiencing homelessness in Australia: Perceptions and experiences of key stakeholders. 30(6), e6312-e6321.
8. Wu, Y., Tao, B., Lan, K., Shen, Y., Huang, W., & Wang, F. J. C. o.
i. r. (2022). Reliability and accuracy of dynamic navigation for zygomatic implant placement. 33(4), 362-376.
9. Dimitrova, M., Vlahova, A., Kalachev, Y., Kazakova, R., & Capodiferro, S. J. O. (2023). Future Prospects and Challenges in Additive Manufacturing for Complete Dentures: A Narrative Review. 4(1), 23-35.
10. Cappadona, I., Corallo, F., Cardile, D., Ielo, A., Bramanti, P., Lo Buono, V., . . . Health, P. (2023). Audit as a Tool for improving the quality of Stroke Care: a review. 20(5), 4490.
11. Alghamdi, S., Dixon, N., Al-Senani, F., Al Aseri, Z., Al Saif, S., & AlTahan, T. J. I. J. f. Q. i. H. C. (2024). Effects of a team Quality Improvement method in a national clinical audit programme of four clinical specialties in Ministry of Health hospitals in Saudi Arabia. 36(1), mzad107.
12. Alqarni, M. M., & Aldrees, S. S. J. J. o. E. (2024).
13. Comprehensive Study of Pediatric Dentistry, Quality Assurance, and Dental Education for Future Practitioners. 3(8), 8486–8498-8486–8498.
14. Frantsve-Hawley, J., Abt, E., Carrasco-Labra, A., Dawson, T., Michaels, M., Pahlke, S., . . . Weyant, R. J. J. T. J. o. t. A. D. A. (2022). Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. 153(11), 1041-1052.
15. Leles, C. R., Silva, J. R., Curado, T. F. F., Schimmel, M., & McKenna, G. J. P. r. o. m. (2022). The potential role of dental patient-reported outcomes (dPROs) in evidence-based prosthodontics and clinical care: a narrative review. 131- 143.
16. Gulabivala, K., & Ng, Y. L. J. I. E. J. (2023). Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. 56, 82-115.
17. Sailer, I., Karasan, D., Todorovic, A., Ligoutsikou, M., & Pjetursson, B. E. J. P. (2022). Prosthetic failures in dental implant therapy. 88(1), 130-144.
18. Lebleu, J., Daniels, K., Pauwels, A., Dekimpe, L., Mapinduzi, J., Poilvache, H., & Bonnechère, B. J. S. (2024). Incorporating Wearable Technology for Enhanced Rehabilitation Monitoring after Hip and Knee Replacement. 24(4), 1163.
19. Calheiros-Lobo, M. J., Calheiros-Lobo, M., & Pinho, T. J. D. J. (2023). Esthetic perception of different clinical situations of maxillary lateral incisor agenesis according to populations with dental and non-dental backgrounds: a systematic review and meta-analysis. 11(4), 105
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