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Repair of distal tibia fracture: which procedure is best?

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A study by Oxford Trauma, a research group at the University of Oxford, has compared two methods for repairing a fracture of the distal tibia, revealing which results in better outcomes.

The researchers found that intramedullary nail fixation provides improved quality of life for patients in the 12 months following a distal tibia fracture and costs less than locking plate fixation.

The shin bone (tibia) is the most commonly broken bone in the leg. Injuries in the lower part of the shin bone (distal tibia) usually require surgery, and the two most common types of operation performed for this fracture are modern locking plate fixation and intramedullary nail fixation.

In a randomised clinical trial that involved 321 adults with displaced tibial fracture, the researchers aimed to establish which procedure provides better outcomes for patients.

Using the Disability Rating Index, patients reported their own outcomes at three, six and 12 months after their fracture. Further information was also collected on the patient’s quality of life, complications suffered and associated costs of the treatment.

The Disability Rating Index of both groups of patients improved in the months after their surgery, although patients were not back to normal even a year later, the researchers said.

Patients who had nail fixation of their tibial fracture showed evidence of improvement at three months but there were no differences between the treatments after six months. There was also no difference in the number of complications suffered by each group, but further surgery was more common in the ‘locking’ plate group and quality of life was higher in the nail fixation group.

Additionally, the economic analysis showed that nail fixation was cheaper than locking plate fixation.

The findings have been published in JAMA, the Journal of the American Medical Association.