Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): Plating versus intramedullary nailing

Objective: The purposes of this study were to review distal tibia shaft fractures treated with a plate or a nail and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Design: Retrospective review. Setting: Two Level I trauma centers. Patient/Participants: We retrospectively reviewed 111 patients with 113 extra-articular distal tibia fractures between 4 and 11 cm proximal to the plafond. Seventy-six were treated with an intramedullary nail and 37 were treated with a medial plate. Twenty-nine (27%) of the concomitant fibula fractures were fixed. Main Outcome Measurements: Complications and secondary procedures were evaluated in 111 patients after a mean of 24 months (range, 12-84 months). Results: A total of 111 patients with 113 fractures of the distal tibia were reviewed. Their mean age was 39.1 years, 69% were men, and 30% had open fractures. Four patients underwent additional procedures for soft tissue coverage. None of these had infection. Five patients (4.4%) developed osteomyelitis: four after intramedullary nailing (5.3%) and one after plating (2.7%). Nine patients (12%) had delayed union or nonunion after nailing. One patient (2.7%) had a nonunion after plating (P = 0.10). Nonunion was more common after concurrent fixation of the fibula (14% versus 2.6%, P = 0.04). Angular malalignment of >= 5 degrees occurred in 22 patients with nails (29%) and 2 with plates (5.4%, P = 0.003). Eight patients had malunions of >= 10 degrees. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (38%, P = 0.006) but was not related to fibula fixation. Painful hardware was removed in six patients (7.9%) with nails and in two patients (5.4%) with plates. Conclusions: Distal tibia fractures may be treated successfully with plates or nails. Delayed union, malunion, and secondary procedures were more frequent after nailing. Randomized prospective assessment may further clarify these issues and provide information about costs associated with these fractures.