Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13 S11 p = 0.936), indicating absence of any relevant difference between nails and plates with regard to functional recovery. Patients in the plate group had a slightly higher relative risk of wound infections (RR 1.54, 95% Ci 0.54 to 4.37, p = 0.42), with an absolute risk difference of 4%. There was no difference in the risk of delayed or non-unions (RR 0.95, 95% Ci 0.36 to 2.52). Conclusion: Given the best available data it is difficult to make a formal evidence-based decision in fixing fractures of the distal tibia. The zero effect may prohibit meaningful RCTs in the future, unless they are designed as equivalence or non-inferiority trials. F3.3 Comparison of functional and radiologic outcomes of nail and plate fixation in distal tibial diaphysis fractures up to 4 cm distance to joint line U. Yavuz 1 , S. S¨ ok ¨ uc ¨ u 1 , B. Demir 1 , T. Yıldırım 1 , Ç. Özcan 1 , Y.S. Kabukcuoglu 1 . 1 Baltalimani Bone Diseases, Education and Research Hospital, Istanbul, Turkey Introduction: Purpose: In this study we compared functional and radiologic outcomes of surgical fixation by nail and plate methods for extra-articular distal tibial fractures. Materials and Method: 55 patients who were operated for distal tibal diaphysis fracture are included in study. Mean follow-up period was 27.6 months (12–82 months). 21 (38.2%) of the patients were treated by nail and 34 (61.8%) were treated by plate. 45 (81.8%) of the patients had fibular fractures. Patients were evaluated for nonunion, malunion, infection and clinically with the AOFAS scoring system. Results: Mean age was 42 (15–72). 32 (58.2%) of the patients were male and 23 (41.8%) were female. Mean distance to joint line was found 72 (42–89) mm in nail group and 56 (33–90) mm in plate group. 33 (60%) of the patients classified as 42-A1, 11 (20%) were 42-A2 and 11 (5.4%) were 42-A3 according to AO classification and no significant difference was found in range between two groups. 9 (16.2%) of the patients had open fracture and treated by plate (p = 0.100). 3 patients who were treated by plate method had nonunion and additional procedures for union have been applied. One patient had infection. There were no significant differences (p = 0.211) between patients who required material extraction for irritation. Patellofemoral pain in nail group was significant however was not effecting quality of life and labour. None of the patients had malunion over 10°. There were no significant difference between both groups in patients who healed with 5° or more angulation for implant selection. There were no significant differences between both groups according to union time, AOFAS score, accompanying fibular fracture and malunion. Conclusion: In distal tibia metaphysodiaphyseal fractures which have 4 cm distance to joint, nail and plate methods could be preferred with confidence. Besides, nail method has additional advantages as, being less invasive, allowing early rehabilitation, and being economic. F3.4 A time proven simple physiologic technique: fixation of syndesmotic ruptures with fibula fractures by ANK nail N. Aksu 1 , B. Abay 1 , R. Soydan 1 , C. Kopuz 1 , T. Aksu 2 , A. Nedim Kara 1 . 1 Istanbul Bilim University Florence Nightingale Hospital Ortophaedics and Traumatology Department, 2 Bahcesehir University Medical Faculty Ortophaedics and Traumatology Department, Turkey Introduction: The ANK device was developed for the treatment of fractures of the lateral malleolus together with rupture of the syndesmosis at 1982 by senior author. We evaluated the results of lateral malleolus fractures with syndesmosis injuries fixed by ANK elastic intramedullary nail. Materials and Methods: We collected the data of 15 patients treated by ANK nail between May 2007 and December 2012. The mean follow-up was 36.6 (8–68) months. The fractures were evaluated according to the Lauge-Hansen classification; 8 cases were evaluated as supination-external rotation, 3 cases were pronation-abduction, and 4 cases were pronation-external rotation type fractures. Results: AOFAS scores were between 80 and 100 (mean 93.8). 12 (80%) patients were evaluated themselves as excellent, 2 (13.3%) as good, 1 (6.6%) as fair. Conclusion: ANK nail provides the anatomic reduction of the fracture and the syndesmosis, allowing the physiologic movements of the fibula from the beginning. This nail provides effective stability in addition with other benefits like being less space occupying causing no dermal complications, allowing early physiologic mortis movement thereby creating less complaints, and lastly does not need removal. F3.5 Minimally invasive plate osteosynthesis or intramedullary nailing in the treatment of extra-articular distal tibia fractures? A. Utkan 1 , K.U. Ceritoglu 1 , C.C. Kose 1 , A. Ciliz 1 , M.E. Uludag 1 . 1 Ankara Numune Research and Training Hospital, Ankara, Turkey Introduction: The optimal treatment of fractures of the distal tibia without major disruption of the ankle joint has not been well defined. In this retrospective study we reviewed our results of distal tibia shaft fractures treated with minimally invasive percutaneous plate osteosynthesis. Materials and Methods: We reviewed the results of our patients treated by MiPPO for extra-articular distal tibia shaft fracture (OTA 42) between 2009 and 2011. All the fractures were closed except two, which were Gustillo anderson Type 1. There were fifteen patients with an average age of 44.1 years (range, 22–64). Patients were reviewed with an average follow-up of 16 months (range, 9–24). Outcome parameters included time to union and weight bearing, occurrence of complications, radiographic analysis and measures of the ankle range of motion. Results: Union was achieved in all patients. The final ranges of motion loss compared to other extremity was less than 10 degrees except one patient who had 15 degrees ankle dorsiflexion loss and also was treated for reflex sympathetic dystrophy. One other patient was treated for deep vein thrombosis occurred postoperative 10th week. No severe malalignment occurred. No patient had a tibia shortening more than 10 mm. The mean time to fully weight bearing was recorded 12.6 weeks. The mean time to radiographic union was 18.4 weeks. Conclusion: Literature review indicates that control of alignment is difficult with intramedullary nailing in the treatment of distal tibia fractures. Our results regarding malalignment were better. There was no difference in time to union. Traditional ORiF of such injuries results in extensive soft tissue dissection and periosteal injury and may be associated with high rates of infection, delayed union, and non-union. We suggest minimally invasive plate osteosynthesis is a better choice for the treatment of closed or type i open extra-articular distal third tibia fractures. F3.6 Comparisons of extra-articular distal tibia fractures: percutaneous locked plating versus intramedullary nailing F. Bilgili 1 , S. S ¨ ok ¨ uc ¨ u 2 , A. Kilic 1 , A.S. Parmaksizoglu 1 , S.K. Çepni 1 , Y.S. Kabukcuoglu 2 . 1 Taksim Training and Research Hospital Orthopaedics and Traumatology Department, 2 Baltalimani Training and Research Hospital Orthopaedics and Traumatology Department, Istanbul, Turkey Introduction: The purposes of this study were to compare and evaluate the clinical and radiographic results, as well as post-operative complication rates, of treatment of extra-articular distal third tibial fractures with intramedullary nailing (IMN) or percutaneous locked plating (PLP). Material and Methods: A retrospective review identified 46 patients with surgically treated distal extra-articular tibial fractures of