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Abstract
Background: Distal tibial fractures present a therapeutic challenge due to their anatomy and limited soft tissue coverage. Surgical fixation methods, including intramedullary (IM) nailing and plate fixation, are commonly employed, but their comparative efficacy regarding bone healing remains debated, especially in resource-limited settings like Rawalpindi, Pakistan.
Objective: To compare radiological bone union at 12 weeks between intramedullary nail fixation and plate fixation in patients with distal tibial fractures.
Methods: A prospective comparative study was conducted at a tertiary care hospital in Rawalpindi over six months (January to July 2025). Eighty patients with closed distal third tibial fractures were enrolled and allocated to receive either IM nail fixation (n=40) or plate fixation (n=40). Surgical procedures followed standardized protocols. Radiological bone union was assessed at 12 weeks postoperatively using anteroposterior and lateral radiographs. Data were analyzed using chi-square tests, with significance set at p < 0.05.
Results: The groups were comparable in demographic and fracture characteristics. Radiological bone union at 12 weeks was significantly higher in the IM nail group (85%) compared to the plate fixation group (65%) (p=0.03). The IM nail group also demonstrated shorter operative times and less blood loss (p<0.05). Although the plate fixation group had higher rates of superficial wound infection and delayed union, malalignment rates were similar between groups.
Conclusion: Intramedullary nail fixation provides superior early bone union and reduced surgical morbidity compared to plate fixation in distal tibial fractures. It is a reliable and efficient method suitable for managing these fractures in trauma centers with limited resources. Further studies with larger cohorts and longer follow-up are recommended.