A Hospital Based Comparative Study to Evaluate the Functional and Radiological Outcome of Dital Tibial Fracture Between Minimally Invasive Percutaneous Plate Osteosynthesis (MIIPO) & Intra Medullary Interlocking Nail (IMIL) at Tertiary Care Center
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 7, Pages 3444-3452
AbstractBackground: 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
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