Extra-Articular Proximal Tibia fractures: Proximal tibia plate versus intramedullary nailing

Introduction: Extra-articular promixal tibial fracture make up to around 10%(1) of all shaft tibia fractures which are most commonly due to high velocity injury. Both conservative and operative management options are available, but conservative management has resulted in many complications. Intramedullary nailing and minial invasive plating are the preferred techniques of the available modalities of operative management. There is not enough evidence regarding the superiority of one of the two techniques. The purpose of this study is to compare these different approaches based on hospital stay, blood loss, union rates, mal/non-union, post-operative range of motion of knee ,period of non-weight bearing , infection rates and implant removal rate. Material and Methods:This is a randomized prospective study conducted on 50 osteoporotic patients with extra-articular proximal tibia fractures treated with minimally invasive proximal tibial plating vs intramedullary nailing at Department of Orthopedics, BJ medical college, Civil hospital Ahmedabad between June 2016 and May 2017. Observation and Results:Patients with intramedullary nailing had lesser duration of stay, lower cost, less infection rate, less implamt removal rate but higher malunion and union rates compared to plating patients. Operative time, time to full weight bearing and range of motion was found to be similar in both. Conclusion:Intramedullary nailing is preferred operative modality over plating because of decreased hospital stay, faster union, decreased operative time and decreased infective rate. However there was no significant difference in range of motion of knee, rate of malunion and nonunion