Comparison of intramedullary nailing versus proximal locking plating in the management of closed extra-articular proximal tibial fracture

Background: To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus minimally invasive proximal tibial plating in treating proximal extraarticular tibial fractures.Methods: This study included 30 cases of extraarticular proximal tibial shaft fractures. They were admitted to our department between March 2014 and June 2016 and treated respectively by closed reduction and ETN (group A, n=15) or minimally invasive proximal tibial plating (group B, n=15). To compare the therapeutic effects between two groups, the intraoperative condition, post-operative function, related complications and malalignment were investigated.Results: All the patients were successfully followed up till radiological union. The average union time for group A was 14.2 months and for group B was 16.7 months. 3 patients in group A developed delayed union and was treated with dynamization and ultimately lead to union whereas 1 patient developed non-union in group B. There were 3 cases of superficial infection in group B cured by antibiotics and repeated dressing change. Moreover, group A showed better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. Functional scores as calculated by the knee rating scale of the hospital for special surgery, 12 (80%) had excellent results in group A compared to 10 (66.66%) in group B which was not statistically significant.Conclusions: Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat extra articular proximal tibial fractures