Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Orthopaedics and Traumatology
Published in: Journal of Orthopaedics and Traumatology 3/2015

Open Access 01-09-2015 | Original Article

Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial

Authors: Ramesh Chand Meena, Umesh Kumar Meena, Gopal Lal Gupta, Nitesh Gahlot, Sahil Gaba

Published in: Journal of Orthopaedics and Traumatology | Issue 3/2015

Login to get access

Abstract

Background

Extra-articular proximal tibial fractures account for 5–11 % of all tibial shaft fractures. In recent years, closed reduction and minimally invasive plating and multidirectional locked intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare plating and nailing options in proximal tibia extra-articular fractures.

Materials and methods

This randomized prospective clinical study was conducted on 58 skeletally mature patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive proximal tibial plating (PTP) or intramedullary nailing (IMN) by trained surgeons at a tertiary trauma center.

Results

Postoperative hospital stay (p = 0.035), time to full weight-bearing, and union time (p = 0.004) were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time (p = 0.082), infection rate (p = 0.738), range of motion of the knee (p = 0.462), or degrees of malunion and nonunion.

Conclusion

Both implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse.

Level of evidence

Level 2, randomized controlled trial.
Literature
1.
Court-Brown CM, McBirnie J (1995) The epidemiology of tibial fractures. J Bone Jt Surg Br 77(3):417–421
2.
DeCoster TA, Nepola JV, el-Khoury GY (1988) Cast brace treatment of proximal tibia fractures. A 10-year follow-up study. Clin Orthop Relat Res 231:196–204PubMed
3.
Jensen DB, Rude C, Duus B, Bjerg-Nielsen A (1990) Tibial plateau fractures. A comparison of conservative and surgical treatment. J Bone Jt Surg Br 72(1):49–52
4.
Milner SA, Davis TR, Muir KR, Greenwood DC, Doherty M (2002) Long-term outcome after tibial shaft fracture: is malunion important? J Bone Jt Surg Am 84-A(6):971–980
5.
Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL et al (2006) Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 20(8):523–528PubMedCrossRef
6.
Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C (2009) Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 23:485–492PubMedCrossRef
7.
Hiesterman TG, Shafiq BX, Cole PA (2011) Intramedullary nailing of extra-articular proximal tibia fractures. J Am Acad Orthop Surg 19(11):690–700PubMed
8.
Naik MA, Arora G, Tripathy SK, Sujir P, Rao SK (2013) Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study. Injury 44(8):1081–1086PubMedCrossRef
9.
Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 315:25–33PubMed
10.
Milner SA (1997) A more accurate method of measurement of angulation after fractures of the tibia. J Bone Jt Surg 79(6):972–974CrossRef
11.
Krettek C, Stephan C, Schandelmaier P et al (1999) The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter intramedullary nails. J Bone Jt Surg Br 81:963–968CrossRef
12.
Beuhler KC, Green J, Woll TS, Duwelius PJ (1997) A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma 11(3):218–223CrossRef
13.
Moed BR, Watson JT (1994) Intramedullary nailing of the tibia without a fracture table: the transfixation pin distractor technique. J Orthop Trauma 8(3):195–202PubMedCrossRef
14.
Archdeacon MT, Wyrick JD (2006) Reduction plating for provisional fracture fixation. J Orthop Trauma 20(3):206–211PubMedCrossRef
15.
Tornetta P, Collons E (1996) Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res 328:185–189PubMedCrossRef
16.
Henley MB, Meier M, Tencer AF (1993) Influences of some design parameters on the biomechanics of the unreamed tibial intramedullary nail. J Orthop Trauma 7(4):311–319PubMedCrossRef
17.
Bhandari M, Audige L, Ellis T (2003) Operative treatment of extraarticular proximal tibial fractures. J Orthop Trauma 17(8):591–595PubMedCrossRef
18.
Cole PA, Zlowodzki M, Kregor PJ (2004) Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 18(8):528–535PubMedCrossRef
19.
Koval K, Clapper M, Brumback R et al (1991) Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma 5(2):184–189PubMedCrossRef
20.
Schutz M, Kaab MJ, Haas N (2003) Stabilization of proximal tibia fractures with the LIS-System: early clinical experience in Berlin. Injury 34(Suppl 1):A30–A35PubMedCrossRef
21.
Uhthoff HK, Bardos DI, Liskova-Kiar M (1981) The advantages of titanium alloy over stainless steel plates for the internal fixation of fractures: an experimental study in dogs. J Bone Jt Surg Br 63-B(3):427–484
Metadata
Title
Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial
Authors
Ramesh Chand Meena
Umesh Kumar Meena
Gopal Lal Gupta
Nitesh Gahlot
Sahil Gaba
Publication date
01-09-2015
Publisher
Springer International Publishing
Published in
Journal of Orthopaedics and Traumatology / Issue 3/2015
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI
https://doi.org/10.1007/s10195-014-0332-9

Other articles of this Issue 3/2015

Journal of Orthopaedics and Traumatology 3/2015 Go to the issue

Original Article

Predisposing factors for early infection in patients with open fractures and proposal for a risk score

Original Article

Biomechanical analysis of acromioclavicular joint dislocation repair using coracoclavicular suspension devices in two different configurations

Original Article

Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults

Original Article

Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model

Case Report

Avulsion of both posterior meniscal roots associated with acute rupture of the anterior cruciate ligament

Letter to the Editor

An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients