July 2026, Volume 4, Issue 7

Author

Balamurugan D, Bharath V and Vignesh Karthick

Abstract

Background: Extra-articular distal third tibial fractures (4 cm to 11 cm proximal to the tibial plafond) are distinct surgical problems because of their subcutaneous position, limited vascularity, and proximity to the ankle joint. Intramedullary interlocking (IMIL) nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) are recognized therapeutic methods however there is still controversy regarding their comparative results. Objectives: To compare clinical and radiological outcomes of IMIL nailing and MIPPO plating in extra-articular distal third tibial fractures. Methods: The present prospective comparative study was undertaken in Sri Ramachandra University. Thirty patients with closed extra-articular AO type 43-A distal third tibial fractures were consecutively enrolled and allocated to IMIL nailing (n = 15) or MIPPO (n = 15). Outcomes were examined at 3, 6 and 9 months by utilizing Modified Klemm and Borner (KB) scoring system. Results: Mean age was 29.87 years; 73.3% were men. Mean union time was substantially less in the nailing group (15.0 weeks vs 17.7 weeks). Nailing led to shorter post-operative immobilisation (6.27 vs 9.20 weeks; p=0.017). The Modified KB score showed excellent results in 66.7% in the nailing group and 20.0% in the plating group (p=0.039). Infection was not seen in the nailing group but occurred in three patients (20%) post plating. Incidence of mal-alignment was similar between groups (33.3% each; p=0.287). Conclusions: IMIL nailing showed better functional outcomes and less infection rates than MIPPO plating for extra-articular distal third tibial fractures. In the nailing procedure, correct guide-wire placement and AP locking are important in reducing mal-alignment. These results need to be confirmed in further randomized controlled trials with larger sample numbers.