Functional and radiological outcomes of distal tibia fractures treated by intramedullary nailing versus plate fixation: Comparative prospective observational study

Abstract

Extra-articular distal tibia fractures remain controversial in terms of optimal surgical fixation, with intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) offering distinct trade-offs in functional recovery and complication profiles. Therefore, it is of interest to compare the 30 Gustilo-Anderson Type I AO Type A distal tibia fractures treated with IMN or MIPPO, evaluating surgical time, blood loss, weight-bearing, union, complications and 6-month AOFAS outcomes. AOFAS scores were comparable between IMN (92.0 ą 4.97) and MIPPO (90.2 ą 4.41; p = 0.303), while IMN had shorter operative time (46.0 versus 78.33 min; p < 0.001) and faster union (4.80 vs 6.07 months; p = 0.014). MIPPO caused less blood loss (85.67 versus 245.33 ml; p < 0.001) and fewer knee symptoms, whereas plating showed more wound complications and IMN more anterior knee pain. Thus, data shows that both techniques yield similar functional outcomes, with implant choice best guided by fracture pattern, soft-tissue status and patient-specific factors.