Intramedullary Nailing Verus Minimally Invasive Plate Osteosynthesis (MIPO) in Management of Distal Tibial Fractures | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 29 September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/zumj.2025.415784.4122 | ||
| Authors | ||
| Nagy Mohamed Foda1; Ali Tawfik El Alfy2; Mohamed Hamdy Tawfek* 3; Mahmoud Abdo Mahmoud4 | ||
| 1Assistant Professor of Orthopedic Surgery, Faculty of Medicine, Zagazig University | ||
| 2Professor of Orthopedic Surgery, Faculty of Medicine, Zagazig University | ||
| 3MBBCH, Faculty of Medicine, Zagazig University | ||
| 4Lecturer of Orthopedic Surgery, Faculty of Medicine, Zagazig University | ||
| Abstract | ||
| Background: Distal tibial fractures remain surgical challenge because of its limited soft-tissue coverage and poor vascularity. Intramedullary nailing (IMN) as well as minimally invasive plate osteosynthesis (MIPO) are widely used, yet the optimal fixation method is still debated. This work compared the outcomes of intramedullary nailing and distal tibial locked plating using the MIPO technique in adult patients with extra-articular distal tibial fractures. Methods: We performed this prospective randomized study on 36 adult patients having closed extra-articular distal tibial fractures randomized into two groups: Group A treated with IMN (n=18) while Group B managed by MIPO using a locked plate (n=18). Outcomes assessed included operative time, union rate, malalignment, infection, secondary procedures, as well as functional recovery utilizing the Olerud–Molander Ankle Score (OMAS). Results: The mean operative time was slightly shorter with IMN (116 min) compared to MIPO (127 min), but without statistical significance (P=0.182). Union time was significantly shorter in the IMN group (13.1 vs. 16.8 weeks; P=0.016). No infections occurred after IMN, whereas two deep infections were observed with MIPO, both progressing to nonunion. Malalignment was more frequent after IMN (2 cases), while rotational deformity and delayed union were observed in MIPO (1 case each). Conclusion: Both IMN and MIPO are effective fixation methods for distal tibial fractures. IMN allows faster union and fewer infections but carries a higher risk of malalignment, whereas MIPO provides better alignment but with slower healing and more infection-related complications. Careful surgical planning and soft-tissue management remain crucial for successful outcomes. | ||
| Keywords | ||
| Intramedullary Nailing; Minimally Invasive Plate Osteosynthesis; Distal Tibial Fractures | ||
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