European Journal of Molecular & Clinical Medicine

Background: The study was conducted with the aim to evaluate the management of distal tibial fractures with IM nailing, external fixator and MIPO and determine which one is optimal for each individual patient.
Methods: A total of 60 patients were treated for distal tibial fracture using different modalities according to the fracture pattern and skin condition. Clinical, functional and radiological evaluation was done for each modality. Patients were assessed for complications like ankle
stiffness, wound discharge, non-union at each follow up.
Results: The mean AOFAS score was highest in the patients treated with MIPO followed by IM nailing and External Fixator and the difference was statistically significant. Most of the complications were found in the patients treated with External Fixator followed by MIPO and IM nailing. And most number of varus and valgus deformities were found in the patients treated with External Fixator and IM nailing and least in the patients treated with MIPO.
Conclusion: MIPO was a better treatment modality than IM nailing and External fixator from clinical, functional and radiological perspectives.

Background: Distal tibial metaphysis is defined by constructing a square, with sides of length defined by widest portion of tibial plafond. Various surgical modalities used for these fractures include closed intramedullary nailing, plating by open or closed methods, and various types of external fixators. The purpose of this prospective study was to compare the two primary modalities of treatment for these fractures: namely, distal tibial locking compression plate by Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) and closed intramedullary interlocking nailing (IMIL), and to know the efficacy of these techniques in the management of closed fractures of distal tibia.
Materials& Methods: A hospital based prospective comparative study done on 30 adult patients with fractures of lower third tibia admitted in department of Orthopaedics at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India during one year period. All patients with distal tibiafractures who satisfy the inclusion criteria have been included in the study. Patients willbe allocated randomly into two groups using computer generated random numbers i.e., IMIL group and MIPPO group each with 15 patients. Patients were followed up for 3 months, 6 months, and 12 months for clinical, radiological and functional outcome evaluation.
Results: Mean age of the patients in IMIL group is 40.56 ± 11.23 years and 44.32 ± 15.46 years in MIPPO group. The most common mode of injury was found to be Road Traffic Accident (RTA), seen in 63.33% of the patients, followed by fall 23.33%, sports injury 6.66% and direct blow 6.66%. The functional results, as assessed by Teeny And Weiss Criteria (Functional Evaluation of Ankle), showed that majority (60%) of the patients in the study hadgood functional results (IMlLN: 66.66%; MIPPO: 53.33%) and 33.33% had excellent results (IMILN: 26.66%;MIPPO: 40%). The difference in functional outcome showed mean score of 84.36 ± 8.78 in IMIL group where as in MIPPO group it is 84.12± 9.65. Using Chi-square test, these differences were not found to be statistically significant (P >0.05). In our study, most of the patients had no complications. In patients who had complications, in IMIL group most common complication is superficial infection (13.33%) followed by malunion (6.66%) and deep infection (6.66%), whereas in MIPPO group most common complication was deep infections (13.33%) and implant failure (13.33%) and delayed union (3.33%).
Conclusion: We concluded that multidirectional locked nailing is an efficient method for treating distal tibia fracture. Compared with MIPO, IMIL nailing should still be considered the gold standard for distal tibia fracture management

Background: The management of the fracture of lower third tibia remains a great
challenge to the surgeon. The present study was aimed to evaluate and compare the
intraoperative and postoperative outcomes between plate fixation, and
intramedullary nail for identifying proper indications of both methods of fixation.
Patients and Method: During 2015 - 2019, 96 cases with distal tibial fractures had
been treated using either M.I.P.O technique or Expert intramedullary nailing
technique, in a prospective study conducted in Zagazig University Hospitals. 48 cases
had been treated by M.I.P.O technique and 48 cases had been treated by Expert
intramedullary nailing technique.
Results: The results suggest that M.I.P.O technique was not always the best choice for all
types of fractures of lower third tibia. Expert I.M.N, with less soft tissue disruption, good
coronal, and sagittal alignment, was considered a standard operative treatment for
diaphyseal tibial fractures. However, cases with I.M.N should follow weight-bearing
restrictions until there is obvious callus formation in order to prevent malunion, broken
distal screws, or propagation of nail into ankle joint.
Conclusion: The study suggests that both Expert I.M nailing, and M.I.P.O.
techniques were appropriate treatments of distal tibial fractures. M.I.P.O. fixation,
and Expert I.M nailing were safe, and effective treatment options for fractures of
lower third tibia, because both of them could provide similar good function
outcomes. Expert I.M nailing must have the priority for distal tibial fractures with
soft tissue injury, or fractures that occurred more than 5 cm from the tibial plafond.
M.I.P.O should have the priority for distal tibial fracture with good skin condition,
soft tissue condition, or fractures that occurred less than 5 cm from tibial plafond.

Background:Distal tibia fractures are challenging injuries. They are often caused by high
energy axial compressive, direct bending or low energy rotation forces. These fractures
constitute less than 10% of all tibial fractures. The aim of treating the fracture is to preserve
normal mechanical axis, ensure joint stability and restore a near full range of motion. This is a
difficult task to accomplish in each and every case due to compromised soft tissue condition,
variable bone quality and associated medical conditions. Distal tibia fractures are devastating
injuries that are usually due to highenergy
mechanisms such as falling from heights or motor
vehicle accidents. They may also occur from lowenergy
mechanisms, which are seen in
rotational injuries around the ankle. Results of conventional osteosynthesis with plates have
been suboptimal with reported complications of wound infection, skin breakdown and delayed
union or nonunion,
requiring secondary surgical intervention. Locking compression plating
has gained popularity and is being used frequently for fixation of distal tibia fractures. With the
use of minimal invasive techniques excellent results are obtained in complex fractures