Vol.:(0123456789) 1 3 European Journal of Orthopaedic Surgery & Traumatology https://doi.org/10.1007/s00590-020-02726-y ORIGINAL ARTICLE Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fbula fxation Ankur Kariya 1  · Pramod Jain 1  · Kisan Patond 1  · Anuj Mundra 2 Received: 9 May 2020 / Accepted: 25 June 2020 © Springer-Verlag France SAS, part of Springer Nature 2020 Abstract Introduction Distal tibia fractures have been managed conservatively as well surgically. A large number of implants have been used for surgical management of these fractures. No treatment method or implant has been proven to be superior to others. In this prospective comparative study, the complications and outcome of distal tibia fractures managed with intramedullary nails and minimally invasive plate osteosynthesis has been compared. Further, the role of fbula fxation in these fractures has been evaluated. Materials and method One hundred and ffty-four patients of distal tibia fractures with concomitant fbula fractures were randomized into 4 treatment groups based on predetermined inclusion criteria. Functional outcome in these groups was compared based on AOFAS score at 1 year. Intra-operative, post-operative parameters as well as radiological alignment, complications and the need for reoperation were also compared in these groups. Result The functional outcome in all four treatment groups was similar. The duration of surgery and radiation exposure was higher with minimally invasive plate osteosynthesis. There was no improvement in outcome with plating of fbula. However, fxation of fbula improved the rotational alignment in distal tibia fractures. Conclusion Although there is no diference in outcome of distal tibia fractures with either nailing or minimally invasive plating, nailing is recommended for closed displaced extraarticular fractures. Fixation of fbula should not be done routinely but should be reserved only for a few specifc fracture patterns. Introduction Fractures of shaft tibia are one of the most common fractures encountered by an orthopaedic surgeon. Of these, the frac- tures of distal tibia present a challenge to the surgeon. Owing to poor muscle cover, compromised vascularity and proxim- ity to the ankle, distal tibia fractures are often complicated with non-union, malunion and infection [1]. Although distal tibia fractures may be managed conserva- tively, surgical management remains the mainstay of treat- ment for these fractures. Surgical management of distal tibia fractures is associated with a better outcome as well as a rapid return to full function [2]. Distal tibia fractures may be managed with closed reduction and internal fxation with intramedullary nailing or with open reduction and internal fxation with plating. Minimally invasive percutaneous plate osteosynthesis may also be done for these fractures. Closed displaced extra-articular fractures of distal tibia have been managed with intramedullary nails (IMN) as well as with plates and screws with good functional outcome Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00590-020-02726-y) contains supplementary material, which is available to authorized users. * Ankur Kariya ankurkariyaorth@gmail.com Pramod Jain pramodjain@mgims.ac.in Kisan Patond drkrpatond@gmail.com Anuj Mundra anuj_mundra87@mgims.ac.in 1 Department of Orthopaedics, MGIMS, Sewagram, Wardha 442 102, India 2 Department of Community Medicine, MGIMS, Sewagram, Wardha 442 102, India